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Enhanced recovery ERAS for elderly: a safe and beneficial pathway in colorectal surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Enhanced recovery after surgery (ERAS) pathway includes recovery goals requiring active participation of the patients; this may be perceived as “aggressive” care in older patients. The aim of the present study was to assess whether ERAS was feasible and beneficial in older patients.

Methods

Since June 2011, all consecutive colorectal patients were included in an ERAS pathway and documented in a dedicated prospective database. This retrospective analysis included 513 patients, 311 younger patients (<70 years) and 202 older patients (≥70 years). Outcomes were adherence to the ERAS pathway, functional recovery, postoperative complications, and hospital stay.

Results

Older patients had significantly more diabetes, malignancies, cardiac, and respiratory co-morbidities; both groups underwent similar surgical procedures. Overall adherence to the ERAS pathway was in median 78 % in younger and 74 % in older patients (P = 0.86). In older patients, urinary drains were kept longer (P = 0.001), and oral fluid intake was reduced from day 0 to day 3 (P < 0.001). There were no differences in mobilization and intake of nutritional supplements. Postoperative complications were similar for both comparative groups (51.5 vs. 46.6 %, P = 0.32). Median length of stay was 7 days (IQR 5–13) in older patients vs. 6 days (IQR 4–10) in the younger group (P = 0.001).

Conclusion

Adherence to the ERAS pathway was equally high in older patients. Despite more co-morbidities, older patients did not experience more complications. Recovery was similar and hospital stay was only 1 day longer than in younger patients. ERAS pathway is of value for all patients and does not need any adaptation for the elderly.

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Authors and Affiliations

  1. Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland

    J. Slieker, V. Addor, Nicolas Demartines & M. Hübner

  2. Faculty of Medicine, UNIL University, Lausanne, Switzerland

    P. Frauche & J. Jurt

  3. Department of Anesthesiology, University Hospital CHUV, Lausanne, Switzerland

    C. Blanc

Authors
  1. J. Slieker
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  2. P. Frauche
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  3. J. Jurt
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  4. V. Addor
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  5. C. Blanc
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  6. Nicolas Demartines
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  7. M. Hübner
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Corresponding author

Correspondence to Nicolas Demartines.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Additional information

J. Slieker and P. Frauche contributed equally

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Slieker, J., Frauche, P., Jurt, J. et al. Enhanced recovery ERAS for elderly: a safe and beneficial pathway in colorectal surgery. Int J Colorectal Dis 32, 215–221 (2017). https://doi.org/10.1007/s00384-016-2691-6

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  • DOI: https://doi.org/10.1007/s00384-016-2691-6

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