Safety and efficacy of an enhanced recovery after surgery protocol for elderly patients undergoing colorectal surgery

Abstract

Purpose: The purpose of this study was to evaluate the safety and efficacy of an enhanced recovery after surgery (ERAS) protocol in elderly patients undergoing colorectal cancer surgery. Methods: The study included 273 patients undergoing laparoscopic colorectal surgery conducted following the ERAS protocol from June 2015 to April 2021 and 63 patients undergoing laparoscopic colorectal surgery according to conventional care (April 2014 to June 2015). Results: We compared elderly patients (age ≥75 years) in the ERAS and conventional care groups. The median (range) length of hospital stay (LOHS) was significantly shorter in the ERAS group (9 [4–95] days with ERAS vs. 13 [4–37] days with conventional care, p < 0.001), but the complication rate (Clavien–Dindo grade 2 or more) was similar (16.8% ERAS vs. 18.5% conventional care, p = 0.784). We found no significant differences between groups in postoperative mortality rates, reoperation rates, and readmission rates within 30 days. In a comparison of elderly and non-elderly patients receiving ERAS, the elderly group had significantly longer median (range) LOHS (8 [3–104] days for non-elderly vs. 9 [4–95] days for elderly patients, p = 0.028). Furthermore, overall compliance with the ERAS protocol was lower and median LOHS significantly longer for patients undergoing proctectomy compared with those undergoing colectomy. Conclusion: The ERAS protocol shows efficacy and safety for elderly patients undergoing laparoscopic colorectal cancer surgery, but proctectomy remains a challenge for adult patients of any age.