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Age is an independent risk factor for increased morbidity in elective colorectal cancer surgery despite an ERAS protocol

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Abstract

Introduction

Elderly patients with colorectal cancer are high-risk surgical candidates. ERAS protocols have been developed to mitigate against these risks. We performed this study to quantify the risks which elderly patients face and then to determine independent risk factors for short-term ERAS-specific outcomes.

Methods

An analysis of a prospectively collected audit database of all patients who underwent elective colorectal cancer resection within an ERAS framework from January 2018 to December 2018 was performed. Elderly was defined in our study as age ≥ 65 years.

Results

There were 172 elective colorectal cancer resections performed. Ninety-seven (56.4%) were elderly. Elderly patients were at increased risk of developing post-operative complications (33.0% vs 16.0%, p = 0.011), longer time to diet (3.4 vs 2.2 days, p = 0.001), and longer hospital stay (10.9 vs 6.7 days, p = 0.007). Independent risk factors were determined for the abovementioned three outcomes. Elderly status was the only risk factor for increased complications (OR 2.61 95% CI (1.05–6.51), p = 0.040). For delayed time to soft diet, male gender (OR 6.67(1.92–20.0), p = 0.002), open approach (OR 9.06(2.26–36.30), p = 0.002), and increased operative time (OR 1.01(1.00–1.01) p = 0.014) were risk factors. Finally, elderly age (OR 5.53(1.82–16.84), p = 0.003), leucocyte count (OR 1.39(0.76–2.57), p = 0.038), open approach (OR 5.26(1.41–19.62), p = 0.013), operative time (OR 1.01(1.00–1.01), p = 0.021), and Clavien-Dindo classification (OR 7.97(1.27–49.88), p = 0.027) were risk factors for prolonged length of stay.

Conclusion

Elderly patients are intrinsically at risk for increased complications, longer time to soft diet and longer hospital stay. ERAS protocols may need to be specifically tailored for elderly patients.

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Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Dedrick Kok Hong Chan, Jia Jun Ang, Jarrod Kah Hwee Tan & Daryl Kai Ann Chia

  2. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Dedrick Kok Hong Chan

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Contributions

Dedrick Kok Hong Chan, Jia Jun Ang, Jarrod Kah Hwee Tan, and Daryl Kai Ann Chia participated in the collection of data, the analysis of data, and the drafting and final editing of the manuscript. Dedrick Kok Hong Chan participated in the writing of the manuscript, the collection of data, the analysis of data, the drafting and final editing of the manuscript, and the overall management of the manuscript.

Corresponding author

Correspondence to Dedrick Kok Hong Chan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interests.

Research involving human participants

This article does not contain any studies with human participants performed by any of the authors. This study has been approved by the National Healthcare Group Domain Specific Review Board, with Reference Number 2019/00192.

Informed consent

Consent from individual participants was not obtained for this study. Waiver of consent was obtained from the ethic committee due to the nature of the study.

Impact statement

This article demonstrates that in spite of an ERAS protocol, elderly patients perform worse in terms of increased comorbidities, delayed time to soft diet, and prolonged hospital stay to their younger counterparts. The importance of these findings is that ERAS protocols should be tailored to meet the specific requirements of elderlies rather than a one size fits all approach in which young and elderly patients undergo the same protocol.

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ERAS protocol used in our institution (DOCX 14 kb)

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Chan, D.K.H., Ang, J.J., Tan, J.K.H. et al. Age is an independent risk factor for increased morbidity in elective colorectal cancer surgery despite an ERAS protocol. Langenbecks Arch Surg 405, 673–689 (2020). https://doi.org/10.1007/s00423-020-01930-y

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  • DOI: https://doi.org/10.1007/s00423-020-01930-y

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