International Journal of Colorectal Disease

, Volume 32, Issue 2, pp 215–221 | Cite as

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

  • J. Slieker
  • P. Frauche
  • J. Jurt
  • V. Addor
  • C. Blanc
  • Nicolas DemartinesEmail author
  • M. Hübner
Original Article



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.


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.


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).


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.


Enhanced recovery after surgery Postoperative complications in elderly Colorectal surgery Adherence 


Compliance with ethical standards

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.

Sources of funding



  1. 1.
    Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38(6):1531–1541CrossRefPubMedGoogle Scholar
  2. 2.
    Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29(4):434–440CrossRefPubMedGoogle Scholar
  3. 3.
    Roulin D, Donadini A, Gander S, Griesser AC, Blanc C, Hubner M et al (2013) Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. The British journal of surgery 100(8):1108–1114CrossRefPubMedGoogle Scholar
  4. 4.
    Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J et al (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146(5):571–577CrossRefPubMedGoogle Scholar
  5. 5.
    Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X (2012) Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Color Dis 14(8):1009–1013CrossRefGoogle Scholar
  6. 6.
    Baek SJ, Kim SH, Kim SY, Shin JW, Kwak JM, Kim J (2013) The safety of a "fast-track" program after laparoscopic colorectal surgery is comparable in older patients as in younger patients. Surg Endosc 27(4):1225–1232CrossRefPubMedGoogle Scholar
  7. 7.
    Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A (2014) A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Color Dis 16(12):947–956CrossRefGoogle Scholar
  8. 8.
    Kisialeuski M, Pedziwiatr M, Matlok M, Major P, Migaczewski M, Kolodziej D et al (2015) Enhanced recovery after colorectal surgery in elderly patients. Wideochir Inne Tech Maloinwazyjne 10(1):30–36PubMedPubMedCentralGoogle Scholar
  9. 9.
    Feroci F, Lenzi E, Baraghini M, Garzi A, Vannucchi A, Cantafio S et al (2013) Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery. Surg Laparosc Endosc Percutan Tech 23(3):259–265CrossRefPubMedGoogle Scholar
  10. 10.
    Verheijen PM, Vd Ven AW, Davids PH, Vd Wall BJ, Pronk A (2012) Feasibility of enhanced recovery programme in various patient groups. Int J Color Dis 27(4):507–511CrossRefGoogle Scholar
  11. 11.
    Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N et al (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg 37(2):259–284CrossRefPubMedGoogle Scholar
  12. 12.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fiore JF Jr, Bialocerkowski A, Browning L, Faragher IG, Denehy L (2012) Criteria to determine readiness for hospital discharge following colorectal surgery: an international consensus using the Delphi technique. Dis Colon rectum 55(4):416–423Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Visceral SurgeryUniversity Hospital CHUVLausanneSwitzerland
  2. 2.Faculty of MedicineUNIL UniversityLausanneSwitzerland
  3. 3.Department of AnesthesiologyUniversity Hospital CHUVLausanneSwitzerland

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