Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care

Tejedor, Patricia; Pastor, Carlos; Gonzalez-Ayora, Santiago; Ortega-López, Mario; Guadalajara, Héctor; García-Olmo, Damián

doi:10.1007/s00384-018-3057-z

Cited by 54 publications

(27 citation statements)

References 27 publications

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“…Similar to previous studies [18][19][20], our results showed that the implementation of ERAS program was associated with lower complications. We believe that there are several factors in the study contributing to the decrease in complications.…”

Section: Discussionsupporting

confidence: 91%

A Comparative Study of Enhanced Recovery After Surgery (ERAS) Program and None-ERAS Traditional Care in Elderly Patients Undergoing Lumbar Arthrodesis

Kong

et al. 2020

Preprint

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Background: 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 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). 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.Trial registration: ChiCTR, ChiCTR1800020513. Registered 2 January 2018, http:// www.chictr.org.cn/ChiCTR1800020513

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Section: Discussionsupporting

confidence: 91%

A Comparative Study of Enhanced Recovery After Surgery (ERAS) Program and None-ERAS Traditional Care in Elderly Patients Undergoing Lumbar Arthrodesis

Kong

et al. 2020

Preprint

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“…Several previous studies have shown that ERAS reduced complications and duration of hospitalization when applied to the elderly, and there was no significant difference in outcomes between the elderly and the young. [14][15][16] While the present findings are comparable to those in the literature, it may be subject to Type 2 sampling error given the sample size and the low probabilities of major adverse events, with only one patient in each cohort (age above or below 75 years) suffering from in-hospital death.…”

Section: Discussionsupporting

confidence: 71%

Suitability of Enhanced Recovery after Surgery (ERAS) Protocols for Elderly Colorectal Cancer Patients

Heng

2020

Smj

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Objective: Enhanced recovery after surgery (ERAS) provides a multimodal approach to postsurgical recovery, seeking to reduce a patient's stress response and promoting recovery. This study aimed to determine the suitability of ERAS protocols for elderly patients above 75 years of age. Methods: This is a retrospective analysis of all patients who had undergone major colorectal resections under ERAS protocols in Khoo Teck Puat Hospital, Singapore and Faculty of Medicine Siriraj Hospital, Thailand between 2013 and 2014. Data collected included patient characteristics and outcomes, including length of hospitalization, and time to first flatus and mobilization. Results: Of the 196 patients studied, 38 were above 75 years of age. Elderly patients were more likely to have more comorbidities, a higher ASA score and a higher POSSUM predicted mortality. They also had an increased risk of developing Clavien 2 complications (OR 2.41, 95% CI 1.10-5.29). Compared to their younger counterparts, elderly patients did not have a delay in first flatus or mobilization. However, they tended to stay longer (7.89 vs. 5.16 days, p<0.001). On multivariate analysis, ASA score of 3 and above was an independent risk factor for a length of stay over 1 week while age was not. Conclusion:This study has shown that elderly patients achieve comparable functional recovery under an enhanced recovery approach. Enhanced recovery after surgery can be adopted regardless of a patient's age.

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“…19 Advances in surgical skills and facilities, better anesthesia, fewer emergency procedures, improved access to healthcare services, and greater availability of effective treatments and postoperative care could contribute to this declining trend. [20][21][22] Furthermore, we found that the largest significant decline in 6-month mortality was in patients with lower comorbidity score, those treated at comprehensive community cancer programs, those who received surgical resection/total surgery, and those aged 75 to 79 years. Advances in perioperative management may allow patients in this group to receive the standard of care and expect similar outcomes to patients enrolled in large randomized clinical trials.…”

Section: Discussionmentioning

confidence: 72%

Early Postoperative Mortality Among Patients Aged 75 Years or Older With Stage II/III Rectal Cancer

Sineshaw

Yabroff

Tsikitis

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Elderly patients with rectal cancer have been excluded from randomized studies, thus little is known about their early postoperative mortality, which is critical for informed consent and treatment decisions. This study examined early mortality after surgery in elderly patients with locally advanced rectal cancer (LARC). Methods: Using the National Cancer Database, we identified patients aged $75 years, diagnosed with clinical stage II/III rectal cancer who underwent surgery in 2004 through 2015. Descriptive analyses determined proportions and trends and multivariable logistic regression analyses were performed to determine factors associated with early mortality after rectal cancer surgery. Results: Among 11,794 patients with rectal cancer aged $75 years, approximately 6% underwent local excision and 94% received radical resection. Overall 30-day, 90-day, and 6-month postoperative mortality rates were 4.2%, 7.8%, and 11.5%, respectively. Six-month mortality varied by age (8.4% in age 75-79 years to 18.3% in age $85 years), and comorbidity score (10.1% for comorbidity score 0 to 17.7% for comorbidity score $2). Six-month mortality declined from 12.3% in 2004 through 2007 to 10.2% in 2012 through 2015 (P trend 5.0035). Older age, higher comorbidity score, and lower facility case volume were associated with higher 6-month mortality. Patients treated at NCI-designated centers had 30% lower odds of 6-month mortality compared with those treated at teaching/research centers. Conclusions: Six-month mortality rates after surgery among patients aged $75 years with LARC have declined steadily over the past decade in the United States. Older age, higher comorbidity score, and care at a low-case-volume facility were associated with higher 6-month mortality after surgery. This information is necessary for informed consent and decisions regarding optimal management of elderly patients with LARC.

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Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care

Cited by 54 publications

References 27 publications

A Comparative Study of Enhanced Recovery After Surgery (ERAS) Program and None-ERAS Traditional Care in Elderly Patients Undergoing Lumbar Arthrodesis

A Comparative Study of Enhanced Recovery After Surgery (ERAS) Program and None-ERAS Traditional Care in Elderly Patients Undergoing Lumbar Arthrodesis

Suitability of Enhanced Recovery after Surgery (ERAS) Protocols for Elderly Colorectal Cancer Patients

Early Postoperative Mortality Among Patients Aged 75 Years or Older With Stage II/III Rectal Cancer

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