Enhanced Recovery Program for Colorectal Surgery: a Focus on Elderly Patients Over 75 Years Old

Lirosi, Maria Carmen; Tirelli, Flavio; Biondi, Alberto; Mele, Maria Cristina; Larotonda, Cristina; Lorenzon, Laura; D’Ugo, Domenico; Gasbarrini, Antonio; Persiani, Roberto

doi:10.1007/s11605-018-3943-2

Cited by 21 publications

(16 citation statements)

References 37 publications

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“…Indeed, our team have shown that the NutriCatt protocol in the ERAS program reduces LOS without increasing the risk of postoperative complications in patients undergoing liver resections [ 28 ]. Another study [ 29 ] evaluated the impact of the ERAS program (including an early postoperative feeding) on clinical outcomes in elderly patients, reporting a reduction in LOS and an improvement in short-term postoperative complications. These results are relevant in this type of population, since advanced age has been associated with increased postoperative morbidity and mortality due to reduced organ function or reserve and a trend of higher ASA scores and CCI [ 8 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the number of patients having complete nutritional data both at pre-hospitalization and discharge was reduced due to the clinical and management framework in which we operate. Finally, the term “elderly” does not have a standardized definition as regards the surgical risk; we chose 75 years of age as an arbitrary cut-off, according to previously published studies [ 29 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

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NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Rinninella

Biondi

Cintoni³

et al. 2021

Nutrients

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Background: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. Methods: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into “NutriCatt + ERAS” (n = 166) or “standard ERAS” patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01–0.56; p = 0.009). Conclusions: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Rinninella

Biondi

Cintoni³

et al. 2021

Nutrients

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“…Enhanced recovery programs have been shown to significantly decrease time to flatus, time to stool, and length of stay without an increase in complications, mortality, and readmission, which has also been shown to be true in geriatric patients. 26 , 27 In addition, studies have shown decreased rates of delirium in patients on enhanced recovery protocols. 28 , 29 …”

Section: Minimally Invasive Surgery and Enhanced Recovery Protocols: mentioning

confidence: 99%

Care of the Geriatric Colorectal Surgical Patient and Framework for Creating a Geriatric Program: A Compendium From the 2019 American Society of Colon and Rectal Surgeons Annual Meeting

Saur

Montroni

Shahrokni

et al. 2020

Diseases of the Colon &Amp; Rectum

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“…Elderly patients were the target group selected at the beginning of the program design, and the postoperative LOS was shortened to 2-3 days in patients over 80 years of age [7]. As the ERAS protocols were adopted in other surgical specialties, many factors including the characteristics of the perioperative period, the stress on the patients, and compliance rate may affect the benefit of ERAS [8][9][10][11]. Kehlet et al recently emphasized that the ERAS program should be designed and evaluated according to specific surgery and population [12,13].…”

Section: Introductionmentioning

confidence: 99%

Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and none-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study

Kong

et al. 2021

Preprint

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Background: Enhanced recovery after surgery (ERAS) program is an evidence-based improvement over none-ERAS traditional care. The aim of the present study was to analyze the safety, feasibility, and efficacy of an ERAS program in patients over 70 years undergoing lumbar arthrodesis by comparison with none-ERAS traditional care.Methods: During January 2018 to December 2018, patients enrolled received none-ERAS traditional care, while the ERAS program was implemented from January to December 2019. Demographic characteristics, comorbidities, surgical data and postoperative recovery parameters were collected from all patients. Postoperative pain scores were evaluated by visual analog scales (VAS). The clinical outcomes were length of stay (LOS), postoperative complications and postoperative pain scores. Compliance results were also collected.Result: A total of 127 patients were enrolled, including 67 patients in the none-ERAS traditional care group and 60 patients in the ERAS group. The demographic characteristics and comorbidities of the two groups showed no significant differences. The LOS of patients treated with ERAS program (13.6±4.0 days) was significantly less than that of patients treated with none-ERAS traditional care (15.6±3.9 days) (p = 0.034). Complication rate was 8.3% in the ERAS group versus 20.9% in the none-ERAS traditional care group (p = 0.048). VAS (back) in the ERAS group was significantly lower on postoperative day (POD) 1 and POD2. Postoperative recovery parameters were improved in the ERAS group. The overall compliance with the ERAS program was 94%.Conclusions: Based on our results, ERAS program is safer and more effective for elderly patients over 70 undergoing lumbar arthrodesis than none-ERAS traditional care.

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Enhanced Recovery Program for Colorectal Surgery: a Focus on Elderly Patients Over 75 Years Old

Cited by 21 publications

References 37 publications

NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Care of the Geriatric Colorectal Surgical Patient and Framework for Creating a Geriatric Program: A Compendium From the 2019 American Society of Colon and Rectal Surgeons Annual Meeting

Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and none-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study

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