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Multimodal Perioperative Rehabilitation for Colonic Surgery in the Elderly

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Abstract

Background

Traditional perioperative care for colonic surgery in elderly patients is associated with increased morbidity and mortality compared to that of younger patients. Although multimodal perioperative rehabilitation has evolved as a valid concept to improve postoperative outcome, its use has not yet been established for colonic surgery in the elderly.

Methods

Data from 24 German hospitals performing multimodal perioperative rehabilitation as the standard perioperative care for elderly patients who have undergone elective colonic resection was assessed in a prospective multicenter study between April 2005 and April 2007.

Results

A total of 742 patients aged ≥70 were examined. Overall compliance with the multimodal care protocol decreased with increasing age. Although laparoscopic colonic surgery was performed in 39.1% of the septuagenarians, the number decreased to 25.1% in the very old patients. The overall complication rate was 22.9% in the septuagenarians (18.1% surgical and 11.6% general complications) and increased in the very old patients to 38.4% (28.0% and 23.6%, respectively) The overall mortality rate was 1.0% and showed no age-specific variations.

Conclusions

Although the overall morbidity did increase with age, it was still less when compared to that of historical groups with traditional care. Therefore, multimodal perioperative rehabilitation should be recommended for the elderly.

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Acknowledgments

Data collection within the Quality Assurance Program “Fast-track” Colon II was funded (in alphabetical order) by: Astra Zeneca Germany, Fresenius Germany, Karl Storz Endoskope Germany, Pfizer Germany, Pfrimmer/Nutricia Germany, and Tyco Healthcare Germany.

Author information

Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Diakoniekrankenhaus Mannheim, Speyerer Strasse 91–93, 68163, Mannheim, Germany

    B. Rumstadt

  2. Universitätsklinik für Allgemein-, Visceral-, Gefäß-, und Thoraxchirurgie, Universitätsmedizin Berlin - Charité, Campus Mitte, Berlin, Germany

    N. Guenther & W. Schwenk

  3. Chirurgische Klinik, Krankenhaus Bad Soden, Kliniken des Main-Taunus-Kreises GmbH, Bad Soden, Germany

    P. Wendling

  4. Chirurgische Klinik I Allgemein-, Viszeral-, und Gefäßchirurgie, Klinikum Aschaffenburg, Aschaffenburg, Germany

    R. Engemann

  5. Klinik für Allgemein-, Viszeral-, und Thoraxchirurgie, Klinikum Nuernberg, Nuernberg, Germany

    C. T. Germer

  6. Klinik für Allgemein- und Viszeralchirurgie, Westpfalz-Klinikum GmbH Standort III Kirchheimbolanden, Kirchheimbolanden, Germany

    M. Schmid

  7. Klinik für Allgemein- und Viszeralchirurgie, Sankt-Marien Hospital, Mülheim/Ruhr, Germany

    K. Kipfmueller

  8. Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Essen, Germany

    M. K. Walz

Authors
  1. B. Rumstadt
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  2. N. Guenther
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  3. P. Wendling
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  4. R. Engemann
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  5. C. T. Germer
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  6. M. Schmid
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  7. K. Kipfmueller
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  8. M. K. Walz
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  9. W. Schwenk
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Corresponding author

Correspondence to B. Rumstadt.

Additional information

This study is conducted for “Fast-track Colon II” (FTCII) Quality Assurance Group. All participating centers are listed at the end of the article.

Appendix

Appendix

The following surgeons and hospitals participated in the “Fast-track”-Colon II registry by providing at least one patient.

P. Wendling, Kliniken des Main-Taunus-Kreises GmbH, Krankenhaus Bad Soden; R. Engemann, Klinikum Aschaffenburg; M. Schmid, Westpfalz-Klinikum GmbH Standort III Kirchheimbolanden; W. Probst, Ammerland Klinik GmbH, Westerstede; K. Kipfmüller, Sankt-Marien Hospital, Mühlheim an der Ruhr; J.M. Müller Charité Campus Mitte, Berlin; B. Rumstadt, Diakoniekrankenhaus, Mannheim; M.K. Walz, Kliniken Essen-Mitte, Essen; K. Nagel, Marienhospital, Aachen; J. Gönninger, Klinikum Minden; K. Schönleben, Klinikum der Stadt Ludwigshafen; B. Vetter, St. Elisabeth-Krankenhaus, Lörrach; H.P. Meyer, Hunsrück Klinik Kreuznacher Diakonie, Simmern; B. Rehnisch, Klinikum des Landkreises Löbau-Zittau gGmbH, Zittau; H.W. Krawzak, Klinikum Niederberg, Velbert ; C.T. Germer, Klinikum Nürnberg; A. Hirner, Universitätsklinikum Bonn; M. Varney, Städtisches Klinikum Gütersloh; D. Ockert, Krankenhaus der Barmherzigen Brüder, Trier; V. Paolucci, Ketteler Krankenhaus, Offenbach; M. Kahle, St. Elisabeth-Krankenhaus, Bad Kissingen; A. Trupka, Klinikum Starnberg; K. Zarras, St. Vinzenz-Hospital Düsseldorf; W. Timmermann, Allgemeines Krankenhaus Hagen.

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Rumstadt, B., Guenther, N., Wendling, P. et al. Multimodal Perioperative Rehabilitation for Colonic Surgery in the Elderly. World J Surg 33, 1757–1763 (2009). https://doi.org/10.1007/s00268-009-0018-2

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  • DOI: https://doi.org/10.1007/s00268-009-0018-2

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