Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS

Santiago Gonzalez-Ayora, Carlos Pastor, Hector Guadalajara, Jose Manuel Ramirez, Pablo Royo, Elizabeth Redondo, Antonio Arroyo, Pedro Moya, Damian Garcia-Olmo, Santiago Gonzalez-Ayora, Carlos Pastor, Hector Guadalajara, Jose Manuel Ramirez, Pablo Royo, Elizabeth Redondo, Antonio Arroyo, Pedro Moya, Damian Garcia-Olmo

Abstract

Purpose: ERAS (enhanced recovery after surgery) programs have proven to reduce morbidity and hospital stay in colorectal surgery. However, the feasibility of these programs in elderly patients has been questioned. The aim of this study is to assess the implementation and outcomes of an ERAS program for colorectal cancer in elderly patients.

Methods: This is a multicenter observational study of a cohort of elderly patients undergoing colorectal surgery within an ERAS program. A total of 188 consecutive patients over 70 years who underwent elective colorectal surgery within an ERAS program at three institutions during a 2-year period were included. The compliance with the ERAS protocol interventions was measure. Complications were evaluated according to Clavien-Dindo classification. Data on length of stay and readmission rates were analyzed.

Results: Early intake and early mobilization were the most successfully carried out interventions. There was a global compliance rate of 56 % of patients for whom compliance was achieved with all measured interventions. The median hospital length of stay was 6 days. Almost 60 % of patients had no complications, 24 % had minor complications while 13 % had major complications; of them, 8 % patients were reoperated. The readmission rate was 6.4 %.

Conclusions: ERAS after colorectal surgery in elderly patients presents as safe and feasible based on good reported outcomes of compliance rates, complications, readmissions, and needs for reoperation.

Keywords: Colorectal cancer; ERAS; Elderly; Enhanced.

Figures

Fig. 1
Fig. 1
Influence of Compliance with ERAS measures in LOS (Kruskal-Wallis test)
Fig. 2
Fig. 2
Reasons for delaying discharge beyond ERAS estimated date. *Estimated discharge in ERAS protocol

References

    1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–616. doi: 10.1002/bjs.1800691019.
    1. Biondi A, Grosso G, Mistretta A, Marventano S, Toscano C, Drago F, Gangi S, Basile F. Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery. BMC Surg. 2013;13(Suppl 2):S12. doi: 10.1186/1471-2482-13-S2-S12.
    1. Morneau M, Boulanger J, Charlebois P, Latulippe JF, Lougnarath R, Thibault C, Gervais N. Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comite de l'evolution des pratiques en oncologie. Can J Surg J Canadien de Chirurgie. 2013;56:297–310. doi: 10.1503/cjs.005512.
    1. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630–641. doi: 10.1016/S0002-9610(02)00866-8.
    1. Kehlet H, Wilmore DW. Fast-track surgery. Br J Surg. 2005;92:3–4. doi: 10.1002/bjs.4841.
    1. Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93:800–809. doi: 10.1002/bjs.5384.
    1. Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149:830–840. doi: 10.1016/j.surg.2010.11.003.
    1. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJHM (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery (review). The Cochrane Library Issue 2
    1. Odermatt M, Miskovic D, Flashman K, Khan J, Senapati A, O'Leary D, Thompson M, Parvaiz A (2015) Major postoperative complications following elective resection for colorectal cancer decrease long-term survival but not the time to recurrence. Color Dis Feb. 17(2):141–149.
    1. Liang LV, Sao Y-f, Zhou Y-b. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Color Dis. 2012;27:1549–1554. doi: 10.1007/s00384-012-1577-5.
    1. Lohsiriwat V. Impact of an enhanced recovery program on colorectal cancer surgery. Asian Pac J Cancer Prev. 2014;15:3825–3828. doi: 10.7314/APJCP.2014.15.8.3825.
    1. Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA. Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg. 2007;24:441–449. doi: 10.1159/000108327.
    1. Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Color Dis. 2014;16:947–956. doi: 10.1111/codi.12718.
    1. Pawa N, Cathcart PL, Arulampalam THA, Tutton MG, Motson RW. Enhanced recovery program following colorectal resection in eldery patient. World J Surg. 2012;36:415–423. doi: 10.1007/s00268-011-1328-8.
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213. doi: 10.1097/.
    1. Ramirez JM, Blasco JA, Roig JV, Maeso-Martinez S, Casal JE, Esteban F, Lic DC. Enhanced recovery in colorectal surgery: a multicentre study. BMC Surg. 2011;11:9. doi: 10.1186/1471-2482-11-9.
    1. Esteban F, Cerdan FJ, Garcia-Alonso M, Sanz-Lopez R, Arroyo A, Ramirez JM, Moreno C, Morales R, Navarro A, Fuentes M. A multicentre comparison of a fast track or conventional postoperative protocol following laparoscopic or open elective surgery for colorectal cancer surgery. Color Dis. 2013;16:134–140. doi: 10.1111/codi.12472.
    1. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78:355–360. doi: 10.1002/bjs.1800780327.
    1. Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Color Dis. 2012;14:1009–1013. doi: 10.1111/j.1463-1318.2011.02855.x.
    1. Jia Y, Jin G, Guo S, Gu B, Jin Z, Gao X, Li Z. Fast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. Langenbeck's Arch Surg / Deutsche Gesellschaft fur Chirurgie. 2014;399:77–84. doi: 10.1007/s00423-013-1151-9.
    1. Gustafsson UO, Hausel J, Thorell A, et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011;146(5):571–577. doi: 10.1001/archsurg.2010.309.
    1. Keller DS, Bankwitz B, Nobel T, Delaney CP (2014) Using frailty to predict who will fail early discharge after laparoscopic colorectal surgery with an established recovery pathway. Dis Colon rectum. Mar 57(3):337–342.
    1. DiFronzo LA, Yamin N, Patel K (2003) Benefits of early feeding and early hospital discharge in elderly patients undergoing open colon resection. J Am Coll Surg 197:747
    1. DiFronzo LA, Yamin N, Patel K. Benefits of early feeding and early hospital discharge in elderly patients undergoing open colon resection. J Am Coll Surg. 2003;197:747. doi: 10.1016/S1072-7515(03)00794-4.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe