Enhanced recovery after colorectal surgery in elderly patients

Abstract

IntroductionThe elderly will soon constitute 20% of the population. Their number is constantly rising, particularly in developed countries. It was found that they particularly benefit from the use of minimally invasive surgery. The Enhanced Recovery After Surgery (ERAS) protocol may further improve clinical outcomes in this group of patients.AimTo assess the implementation of the ERAS protocol in elderly patients submitted to laparoscopic colorectal surgery.Material and methodsNinety-two patients who underwent elective laparoscopic colorectal surgery were included in the study. Patients were divided into group 1 (≤ 65 years) and group 2 (> 65 years). Perioperative care was based on ERAS Society guidelines. Length of hospital stay, time of first stool passage, perioperative complications and readmissions were analyzed.ResultsGroup 2 patients had higher ASA grades in comparison to group 1. In all cases, oral fluid intake started on the day of surgery. The groups did not differ according to oral fluid tolerance, first stool passage time or length of hospital stay. Number and character of perioperative complications were comparable between the two groups. Four patients were readmitted within 30 days after discharge. One patient required reoperation.ConclusionsImplementation of the ERAS protocol is possible regardless of the age of surgical patients. Its use in the elderly allows the length of hospitalization to be shortened and is not associated with higher risk of postoperative complications or readmissions.

C‐reactive protein as a marker of the systemic inflammatory response to surgery reduction within an enhanced recovery after surgery protocol in elective colorectal surgery of the elderly: A prospective cohort study

“…The programme did not reduce the rate of reinventions nor Clavien–Dindo complications. The results are consistent with findings from other medical centres . LOS and readmissions have often been used as a benchmark of the success of a surgical protocol.…”

Enhanced Recovery After Surgery (ERAS) - The Evidence in Geriatric Emergency Surgery: A Systematic Review

“…Two RCTs (17,19) and 3 cohort studies (21,22,26) applied laparoscopic surgery on all patients and Pawa et al (25) on 96%. Four other studies (24,27,29,33) used laparoscopy to varying degrees and one study (18), in contrast, applied solely open surgery.…”

“…In the 3 RCTs, post operative complication rates were [18] RCT Acceptable 1+ Wang et al [19] RCT Acceptable 1+ Partelli et al [20] Cohort Acceptable 2+ Kisialueski et al [21] Cohort Acceptable 2+ Baek et al [22] Cohort Acceptable 2+ Coolsen et al [23] Cohort High quality 2++ Khan et al [24] Cohort Acceptable 2+ Pawa et al [25] Cohort Acceptable 2+ Pedziwiatr et al [26] Cohort Acceptable 2+ Rumstadt et al [27] Cohort Acceptable 2+ Walter et al [28] Cohort Acceptable 2+ Gonzalez-Ayora et al [29] Cohort Acceptable 2+ ERAS in Emergency Gonenc et al [30] RCT Low quality 1-Lohsiriwat et al [31] Cohort High quality 2++ Wisely et al [32] Cohort Acceptable 2+ Roulin et al [33] Cohort Acceptable 2+ Verheijen et al [13] Cohort Acceptable 2+ reduced considerably from 18% to 5% (17), 58.6% to 27.4% (18) and 21% to 5% (18) and more notably when laparoscopy was used for all surgeries (17,19). LOS was reduced by 1.5 to 3.5 and 4 days (17)(18)(19).…”

Systematic scoping review of enhanced recovery protocol recommendations targeting return of gastrointestinal function after colorectal surgery

“…Of 481 manuscripts screened, 37 individual ERPs were published in 37 studies including 41 centres as shown in Figure S1. There were 18 cohort studies, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] seven historically controlled studies, [33][34][35][36][37][38][39] five guidelines, [40][41][42][43][44] four randomized controlled trials (RCTs), [45][46][47][48] one RCT protocol, 49 one case series 50 and one narrative review. 51 Institutions in Europe were the most frequent study locations (25 of 37, 67.6%), followed by North America (10 of 37, 27%), Asia (4 of 37, 10.8%) and Oceania (2 of 37, 5.4%), respectively.…”