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Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to evaluate the benefits of implementing Enhanced Recovery After Surgery (ERAS) protocols in elderly patients undergoing elective colorectal surgery.

Methods

A retrospective non-randomized cohort study was conducted from September 2012 to December 2016. We included patients ≥ 70 years undergoing elective colorectal surgery. Outcome measures, compliance with interventions, and postoperative complications of patients treated under ERAS were case-matched (based on gender, age, type of surgery, and the presence/absence of a temporal stoma) to a retrospective group of patients ≥ 70 years treated under conventional care.

Results

A total of 312 patients (156 ERAS vs. 156 non-ERAS) were included in the study. The ERAS group had a significant reduction of grade III/IV Dindo-Clavien’s postoperative complications when compared with conventional care. ERAS had a positive effect in reducing anastomotic leakage (14.7% non-ERAS vs. 9%) and postoperative mortality (11.5% non-ERAS vs. 1.9% ERAS; p = 0.001). A reduction of 2 days in length of hospital stay was achieved after implementing ERAS (8 (6.75) vs. 6 (5.25); p < 0.0001), while readmission rates remained unaffected. The average of global compliance (GC) with all ERAS interventions was 42%. GC was significantly lower in patients with permanent/temporary stomas and in patients in whom an open approach was performed.

Conclusion

In our experience, ERAS should be implemented without reservations in elderly patients expecting the same goals and benefits as with other age groups. Barriers in achieving a high compliance rate are common and will require a great effort in patient’s education, an intensive perioperative care, and sometimes a change in the surgeons’ practice.

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Acknowledgements

The authors would like to thank Dr. Sara Rosenstone Calvo for editing this manuscript.

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Authors and Affiliations

  1. Department of General Surgery, Division of Colorectal Surgery, University Hospital Fundacion Jimenez Diaz, Madrid, Spain

    Patricia Tejedor, Carlos Pastor, Santiago Gonzalez-Ayora, Mario Ortega-Lopez, Hector Guadalajara & Damian Garcia-Olmo

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  1. Patricia Tejedor
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  2. Carlos Pastor
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  3. Santiago Gonzalez-Ayora
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  5. Hector Guadalajara
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Contributions

Patricia Tejedor and Carlos Pastor contributed equally in analyzing the data and writing the manuscript. The rest of the authors critically revised the paper for important intellectual content. All authors have contributed to the work and agreed on the final version. This manuscript is not being considered by any other journal.

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Correspondence to Patricia Tejedor.

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Tejedor, P., Pastor, C., Gonzalez-Ayora, S. et al. Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care. Int J Colorectal Dis 33, 1251–1258 (2018). https://doi.org/10.1007/s00384-018-3057-z

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