Are enhanced recovery programs in colorectal surgery feasible and useful in the elderly? A systematic review of the literature

Launay-Savary, M.-V.; Mathonnet, Muriel; Theissen, A.; Ostermann, Sandrine; Raynaud-Simon, A.; Slim, K.

doi:10.1016/j.jviscsurg.2016.09.016

Cited by 37 publications

(19 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A secondary objective of this review was to summarise outcomes of ERPs in older patients, without comparison to younger patients or conventional care: the two earlier reviews studied the safety and feasibility of ERPs (by analysing cohort studies comparing different age groups), and their efficacy (by analysing the only two existing RCTs of ERP versus conventional care in older patients [24, 28]). They concluded that ERPs are safe and feasible, with a comparable post-operative morbidity in the younger and older patient population in the majority of the studies, and that ERPs had significantly better outcomes than conventional care [11, 12]. In this novel review we included 8 new studies (we excluded emergency surgery, which explains why two studies from the previous reviews were not included).…”

Section: Discussionmentioning

confidence: 99%

“…In 2014, Bagnall et al published a first review about the safety, feasibility and efficacy of ERPs in patients aged 65 and over undergoing colorectal surgery, including 16 studies published before February 2014 [11]. Launay-Savary et al performed a new search until 2015 and included two extra studies: a meeting abstract and a study later retracted from literature [12]. With new literature emerging since the latest reviews, and ERPs being further standardised, a new systematic literature review was deemed useful.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

et al. 2019

View full text Add to dashboard Cite

Background Enhanced recovery programmes (ERPs) aim to attenuate the surgical stress response and accelerate recovery after surgery, but are not specifically designed for older patients. The objective of this study was to review the components, adherence and outcomes of ERPs in older patients (≥65 years) undergoing elective colorectal surgery. Methods Pubmed, Embase and Cinahl were searched between 2000 and 2017 for randomised and non-randomised controlled trials, before-after studies, and observational studies. The methodological quality of the studies was evaluated using the MINORS quality assessment. The review was performed and reported according to the PRISMA guidelines. Results Twenty-one studies, including 3495 ERP patients aged ≥65 years, were identified. The ERPs consisted of a median of 13 intervention components. Adherence rates were reported in 9 studies and were the highest (≥80%) for pre-admission counselling, no bowel preparation, limited pre-operative fasting, antithrombotic and antimicrobial prophylaxis, no nasogastric tube, active warming, and limited intra-operative fluids. The median post-operative length of stay was 6 days. The median post-operative morbidity rate (Clavien-Dindo I-IV) was 23.5% in-hospital and 29.8% at 30 days. The in-hospital post-operative mortality rate was 0% in most studies and amounted to a median of 1.4% at 30 days. The median 30-day readmission rate was 4.9% and the median reoperation rate was 5.0%. Conclusions ERPs in older patients were in accordance with the ERP consensus guidelines. Although the number of intervention components applied increased over time, outcomes in earlier and later studies remained comparable. Adherence rates were under-reported. Future studies should explore adherence and age-related factors, such as frailty profile, that could influence adherence. Trial registration PROSPERO 2018 CRD42018084756 . Electronic supplementary material The online version of this article (10.1186/s12877-019-1158-3) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Some clinicians may be concerned about the development of adverse events when postoperative rehabilitation is initiated early. 13) In our patients, however, no adverse event was found with the initiation of our proposed protocol. For our patients, whether early rehabilitation could be initiated was carefully considered based on the postoperative condition of each patient.…”

Section: Discussionmentioning

confidence: 49%

Clinical Impact of the Introduction of an Early Rehabilitation Protocol on Infectious Complications in Patients after Gastrointestinal Cancer Surgery

Fukawa

Kakuda

Yoshida

et al. 2019

PRM

View full text Add to dashboard Cite

Background: The clinical importance of postoperative rehabilitation for cancer patients has recently attracted much attention. However, it remains uncertain whether early rehabilitation can prevent infectious complications in patients undergoing gastrointestinal cancer surgery. Methods: The study group consisted of 259 patients who underwent laparoscopic or open surgery for gastrointestinal cancer at our institution between December 2012 and November 2016. Our department proposed a new early rehabilitation protocol for such patients to encourage physical activity after surgery. The protocol was clinically introduced on July 21, 2015. We divided the study subjects into two groups: those who were admitted before the introduction of the new protocol and those admitted after. The frequency of infectious complications, including respiratory infections, and the length of hospital stay after surgery were compared between the two groups. Results: No adverse cardiovascular event associated with the early rehabilitation protocol was experienced. After the protocol was introduced, more than 80% of patients started exercising on the first day after surgery. For patients undergoing open surgery, the frequency of infectious complications was significantly reduced with the introduction of the protocol (p<0.05). Moreover, when open surgery was performed, the protocol significantly shortened the length of hospital stay (p<0.05). Conclusion: Our proposed early rehabilitation protocol for patients who have undergone gastrointestinal cancer surgery was considered to be safe and feasible. The protocol may prevent infectious complications and shorten the hospital stay after such surgery.

show abstract

“…Notably, recovery following acute illness and particularly surgical intervention may be prolonged in the elderly population, as a consequence of a loss of strength, mobility, and functional capacity [23][24][25][26]. Frailty may manifest phenotypically as decline in lean body mass, strength, endurance, balance, walking performance and low activity; patients who have three or more of the ve features of slowness, weakness, exhaustion, weight loss and low physical activity are deemed frail, while those who have none of the features are non-frail.…”

Section: Discussionmentioning

confidence: 99%

Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

Bass¹,

Gillis²,

Cao³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Acute complicated calculous biliary disease (ACCBD) may pose challenges in an ageing population. Frailty and comorbidities increase the potential risks of surgery; thus, surgeons may opt to offer operative treatments less often to their older patients. We set out to capture the incidence and treatment algorithms used across Europe to treat older patients presenting with ACCBD.Methods: Analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Acute Complicated Calculous Biliary Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. The primary outcome measure was operative intervention in patients over and under 65 years of age. Mortalities, post-operative morbidity, time to operative intervention, post-acute disposition and length of hospital stay were measured as secondary outcomes.Results: The median age of the 338 patients admitted to the snapshot was 67 years; 185 patients (54.7%) were over 65 years at time of admission. Significantly fewer patients over 65 underwent definitive surgical treatment, compared with those under 65 (37.8% vs. 64.7%, p <0.001). Surgical complications were seen more frequently in the over 65 cohort. Post-operative mortality was seen in 2.2% of over 65s versus 0.7% under 65(p=0.253). Mean post-operative length of stay was significantly longer in the elderly cohort. In patients surviving to discharge, post-acute convalescence or rehabilitation was required in 13.3% in the elderly cohort versus 1.9% of those under 65 (p=0.002).Conclusions: Elderly patients commonly present with ACCBD. Increased frailty and incidence of comorbid disease in this population increases the potential surgical risk. In our snapshot, elderly patients represented the majority, but far fewer were offered definitive surgical treatment. Post-operative mortality, morbidity, length of post-operative in-hospital stay and the requirement for post-discharge convalescence were higher in this group.

show abstract

Are enhanced recovery programs in colorectal surgery feasible and useful in the elderly? A systematic review of the literature

Cited by 37 publications

References 33 publications

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

Clinical Impact of the Introduction of an Early Rehabilitation Protocol on Infectious Complications in Patients after Gastrointestinal Cancer Surgery

Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

Contact Info

Product

Resources

About