Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery

Abstract

Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients. Despite higher comorbidities, elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates.

Enhanced Recovery After Colorectal Surgery (ERAS) in Elderly Patients Is Feasible and Achieves Similar Results as in Younger Patients

“…A number of prospective and retrospective studies have demonstrated a similar length of stay when older and younger cohorts are compared (Baek et al, 2013; Kahokehr, Sammour, Sahakian, Zargar-Shoshtari, & Hill, 2011; Keller, Lawrence, Nobel, & Delaney, 2013; Pawa, Cathcart, Arulampalam, Tutton, & Motson, 2012; Senagore et al, 2003; Verheijen, vd Ven, Davids, Vd Wall, & Pronk, 2012; Walter et al, 2011), while other studies found longer length of stay in older patients (Feroci et al, 2013; Hendry et al, 2009; Rumstadt et al, 2009). Two randomized controlled trials comparing ERAS with standard of care in elderly patients found significantly reduced length of hospital stay in patients allocated to ERAS care (Jia et al, 2014; Wang et al, 2012).…”

Which Patients Require More Care after Hospital Discharge? An Analysis of Post-Acute Care Use among Elderly Patients Undergoing Elective Surgery

“…[10][11][12] For example, Legner and colleagues 10 noted that, in the state of Washington, surgical patients suffering complications during the index hospitalization had 2.4 times higher odds of discharge to post-acute institutional care. These studies, however, did not describe differences in use of different PAC services, nor did they report the use of PAC associated with specific operations or complications.…”

A systematic review of enhanced recovery care after colorectal surgery in elderly patients

“…1). Sixteen papers were judged to be eligible: two randomized controlled trials (RCTs) [25,26], 11 cohort studies [27][28][29][30][31][32][33][34][35][36][37] and three case series [38][39][40]. There was good inter-rater agreement between reviewers (kappa score 0.896 for search, 0.882 for quality score).…”

“…There was good inter-rater agreement between reviewers (kappa score 0.896 for search, 0.882 for quality score). Five studies were rated as good quality [30,[32][33][34][35], seven as fair quality [25][26][27]29,31,37,38] and four as poor quality [28,36,39,40] (Table S2). There was wide variation of components of ERAS protocols adopted between studies (Table S3), and no studies followed all ERAS components described by the current consensus guidelines [1].…”