Maria Carmen Lirosi1, Flavio Tirelli2, Alberto Biondi1, Maria Cristina Mele3,4, Cristina Larotonda1, Laura Lorenzon1, Domenico D'Ugo1,4, Antonio Gasbarrini4,5, Roberto Persiani1,4. 1. Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC di Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy. 2. Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC di Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy. tirelliflavio@gmail.com. 3. Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC di Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy. 4. Università Cattolica del Sacro Cuore, Milano, Italy. 5. Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Abstract
BACKGROUND: An enhanced recovery after surgery (ERAS) protocol can effectively improve perioperative outcomes in surgical patients by reducing complication rates and hospital stay. However, its application in elderly patients has yielded contradictory results. The aim of this study was to evaluate surgical outcomes in a cohort of elderly patients undergoing colorectal resection in our unit before and after the introduction of ERAS. METHODS: From 328 patients undergoing colorectal surgery in our unit over a 2-year period (2015-2016), 114 patients ≥ 75 years of age were selected. The patients were categorized according to perioperative treatment as pre-ERAS and ERAS patients (respectively, 53 vs 61 patients), and the groups were compared for statistical purposes. Outcome measures included length of hospital stay, recovery of bowel functions, oral feeding, postoperative complications, and readmissions. Compliance with the ERAS protocol was also measured. RESULTS: Groups were homogeneous for all the clinical-surgical variables, with the sole exception of the Charlson index, which was more severe in the ERAS group (p = 0.012). Compared with control patients, ERAS patients reported improved functional recovery (time to first flatus, stool, and oral feeding; p < 0.001). Hospital stay was reduced in ERAS patients overall and by side of resection, excluding rectal procedures. No differences were observed regarding postoperative complications. Of note, an optimal adherence to the protocol was reported, with 79% of items respected. CONCLUSIONS: ERAS can be considered safe in elderly patients undergoing colorectal surgery with a high comorbidity index, providing a reduction in hospital stay and improving short-term postoperative outcomes. Finally, the protocol application was feasible, with a high adherence to the items in this subset of patients.
BACKGROUND: An enhanced recovery after surgery (ERAS) protocol can effectively improve perioperative outcomes in surgical patients by reducing complication rates and hospital stay. However, its application in elderly patients has yielded contradictory results. The aim of this study was to evaluate surgical outcomes in a cohort of elderly patients undergoing colorectal resection in our unit before and after the introduction of ERAS. METHODS: From 328 patients undergoing colorectal surgery in our unit over a 2-year period (2015-2016), 114 patients ≥ 75 years of age were selected. The patients were categorized according to perioperative treatment as pre-ERAS and ERAS patients (respectively, 53 vs 61 patients), and the groups were compared for statistical purposes. Outcome measures included length of hospital stay, recovery of bowel functions, oral feeding, postoperative complications, and readmissions. Compliance with the ERAS protocol was also measured. RESULTS: Groups were homogeneous for all the clinical-surgical variables, with the sole exception of the Charlson index, which was more severe in the ERAS group (p = 0.012). Compared with control patients, ERAS patients reported improved functional recovery (time to first flatus, stool, and oral feeding; p < 0.001). Hospital stay was reduced in ERAS patients overall and by side of resection, excluding rectal procedures. No differences were observed regarding postoperative complications. Of note, an optimal adherence to the protocol was reported, with 79% of items respected. CONCLUSIONS: ERAS can be considered safe in elderly patients undergoing colorectal surgery with a high comorbidity index, providing a reduction in hospital stay and improving short-term postoperative outcomes. Finally, the protocol application was feasible, with a high adherence to the items in this subset of patients.
Authors: Alberto Biondi; Maria Cristina Mele; Annamaria Agnes; Laura Lorenzon; Marco Cintoni; Emanuele Rinninella; Giuseppe Marincola; Domenico D'Ugo; Antonio Gasbarrini; Roberto Persiani Journal: BJS Open Date: 2022-01-06
Authors: Nicole M Saur; Isacco Montroni; Armin Shahrokni; Hiroko Kunitake; Fabio M Potenti; Robert C Goodacre; Bradley R Davis; Francesco Carli Journal: Dis Colon Rectum Date: 2020-11 Impact factor: 4.412