TY - JOUR
T1 - Enhanced Recovery Program for Colorectal Surgery: a Focus on Elderly Patients Over 75 Years Old
AU - Lirosi, Maria Carmen
AU - Tirelli, Flavio
AU - Biondi, Alberto
AU - Mele, Maria Cristina
AU - Larotonda, Cristina
AU - Lorenzon, Laura
AU - D'Ugo, Domenico
AU - Gasbarrini, Antonio
AU - Persiani, Roberto
PY - 2019
Y1 - 2019
N2 - Background: An enhanced recovery after surgery (ERAS) protocol can effectively improve perioperative outcomes in surgical patients by reducing complication rates and hospital stay. However, its application in elderly patients has yielded contradictory results. The aim of this study was to evaluate surgical outcomes in a cohort of elderly patients undergoing colorectal resection in our unit before and after the introduction of ERAS. Methods: From 328 patients undergoing colorectal surgery in our unit over a 2-year period (2015–2016), 114 patients ≥ 75 years of age were selected. The patients were categorized according to perioperative treatment as pre-ERAS and ERAS patients (respectively, 53 vs 61 patients), and the groups were compared for statistical purposes. Outcome measures included length of hospital stay, recovery of bowel functions, oral feeding, postoperative complications, and readmissions. Compliance with the ERAS protocol was also measured. Results: Groups were homogeneous for all the clinical-surgical variables, with the sole exception of the Charlson index, which was more severe in the ERAS group (p = 0.012). Compared with control patients, ERAS patients reported improved functional recovery (time to first flatus, stool, and oral feeding; p < 0.001). Hospital stay was reduced in ERAS patients overall and by side of resection, excluding rectal procedures. No differences were observed regarding postoperative complications. Of note, an optimal adherence to the protocol was reported, with 79% of items respected. Conclusions: ERAS can be considered safe in elderly patients undergoing colorectal surgery with a high comorbidity index, providing a reduction in hospital stay and improving short-term postoperative outcomes. Finally, the protocol application was feasible, with a high adherence to the items in this subset of patients.
AB - Background: An enhanced recovery after surgery (ERAS) protocol can effectively improve perioperative outcomes in surgical patients by reducing complication rates and hospital stay. However, its application in elderly patients has yielded contradictory results. The aim of this study was to evaluate surgical outcomes in a cohort of elderly patients undergoing colorectal resection in our unit before and after the introduction of ERAS. Methods: From 328 patients undergoing colorectal surgery in our unit over a 2-year period (2015–2016), 114 patients ≥ 75 years of age were selected. The patients were categorized according to perioperative treatment as pre-ERAS and ERAS patients (respectively, 53 vs 61 patients), and the groups were compared for statistical purposes. Outcome measures included length of hospital stay, recovery of bowel functions, oral feeding, postoperative complications, and readmissions. Compliance with the ERAS protocol was also measured. Results: Groups were homogeneous for all the clinical-surgical variables, with the sole exception of the Charlson index, which was more severe in the ERAS group (p = 0.012). Compared with control patients, ERAS patients reported improved functional recovery (time to first flatus, stool, and oral feeding; p < 0.001). Hospital stay was reduced in ERAS patients overall and by side of resection, excluding rectal procedures. No differences were observed regarding postoperative complications. Of note, an optimal adherence to the protocol was reported, with 79% of items respected. Conclusions: ERAS can be considered safe in elderly patients undergoing colorectal surgery with a high comorbidity index, providing a reduction in hospital stay and improving short-term postoperative outcomes. Finally, the protocol application was feasible, with a high adherence to the items in this subset of patients.
KW - Colorectal surgery
KW - ERAS
KW - Elderly patients
KW - Enhanced recovery after surgery
KW - Gastroenterology
KW - Outcomes
KW - Surgery
KW - Colorectal surgery
KW - ERAS
KW - Elderly patients
KW - Enhanced recovery after surgery
KW - Gastroenterology
KW - Outcomes
KW - Surgery
UR - http://hdl.handle.net/10807/129415
UR - http://link.springer.com/journal/volumesandissues/11605
U2 - 10.1007/s11605-018-3943-2
DO - 10.1007/s11605-018-3943-2
M3 - Article
SN - 1091-255X
VL - 23
SP - 587
EP - 594
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
ER -