Enhanced recovery after colorectal surgery in elderly patients

Mikhail Kisialeuski, Michał Pędziwiatr, Maciej Matłok, Piotr Major, Marcin Migaczewski, Damian Kołodziej, Anna Zub-Pokrowiecka, Magdalena Pisarska, Piotr Budzyński, Andrzej Budzyński, Mikhail Kisialeuski, Michał Pędziwiatr, Maciej Matłok, Piotr Major, Marcin Migaczewski, Damian Kołodziej, Anna Zub-Pokrowiecka, Magdalena Pisarska, Piotr Budzyński, Andrzej Budzyński

Abstract

Introduction: The elderly will soon constitute 20% of the population. Their number is constantly rising, particularly in developed countries. It was found that they particularly benefit from the use of minimally invasive surgery. The Enhanced Recovery After Surgery (ERAS) protocol may further improve clinical outcomes in this group of patients.

Aim: To assess the implementation of the ERAS protocol in elderly patients submitted to laparoscopic colorectal surgery.

Material and methods: Ninety-two patients who underwent elective laparoscopic colorectal surgery were included in the study. Patients were divided into group 1 (≤ 65 years) and group 2 (> 65 years). Perioperative care was based on ERAS Society guidelines. Length of hospital stay, time of first stool passage, perioperative complications and readmissions were analyzed.

Results: Group 2 patients had higher ASA grades in comparison to group 1. In all cases, oral fluid intake started on the day of surgery. The groups did not differ according to oral fluid tolerance, first stool passage time or length of hospital stay. Number and character of perioperative complications were comparable between the two groups. Four patients were readmitted within 30 days after discharge. One patient required reoperation.

Conclusions: Implementation of the ERAS protocol is possible regardless of the age of surgical patients. Its use in the elderly allows the length of hospitalization to be shortened and is not associated with higher risk of postoperative complications or readmissions.

Keywords: enhanced recovery; evidence-based medicine; fast-track; postoperative care.

References

    1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.
    1. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37:285–305.
    1. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37:259–84.
    1. Wind J, Hofland J, Preckel B, et al. Perioperative strategy in colonic surgery. LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial) BMC Surg. 2006;6:16.
    1. Sosada K, Wiewiora M, Piecuch J, Zurawiński W. Fast track in large intestine surgery – review of randomized clinical trials. Videosurgery Miniinv. 2013;8:1–7.
    1. Delgado S, Lacy AM, Garcia Valdecasas JC, et al. Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc. 2000;14:22–6.
    1. Verheijen PM, Vd Ven AW, Davids PH, et al. Feasibility of enhanced recovery programme in various patient groups. Int J Colorectal Dis. 2012;27:507–11.
    1. Scharfenberg M, Raue W, Junghans T, Schwenk W. “Fast-track” rehabilitation after colonic surgery in elderly patients: is it feasible? Int J Colorectal Dis. 2007;22:1469–74.
    1. Keller DS, Lawrence JK, Nobel T, Delaney CP. Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery. Surg Endosc. 2013;27:4463–8.
    1. Stewart BT, Stitz RW, Lumley JW. Laparoscopically assisted colorectal surgery in the elderly. Br J Surg. 1999;86:938–41.
    1. Ballesta Lopez C, Cid JA, Poves I, et al. Laparoscopic surgery in the elderly patient. Surg Endosc. 2003;17:333–7.
    1. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–77.
    1. Bardram L, Funch-Jensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection. Br J Surg. 2000;87:1540–5.
    1. Marusch F, Koch A, Schmidt U, et al. Colon-/rectal carcinoma prospective studies as comprehensive surgical quality assurance. Chirurg. 2002;73:138–46.
    1. Kehlet H, Buchler MW, Beart RW, et al. Care after colonic operation: is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg. 2006;202:45–54.
    1. Staib L, Link KH, Blatz A, Beger HG. Surgery of colorectal cancer: surgical morbidity and five- and ten-year results in 2400 patients: monoinstitutional experience. World J Surg. 2002;26:59–66.
    1. Stocchi L, Nelson H, Young-Fadok TM, et al. Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum. 2000;43:326–32.
    1. Piątkowski J, Jackowski M. Laparoscopic colon resections – own experience report. Videosurgery Miniinv. 2009;4:135–7.
    1. Basse L, Raskov HH, Hjort Jakobsen D, et al. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg. 2002;89:446–53.
    1. Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003;46:851–9.
    1. Skrovina M, Czudek S, Bartos J, et al. Colorectal cancer complications of laparoscopic resection. Videosurgery Miniinv. 2006;1:142–9.
    1. Smart NJ, White P, Allison AS, et al. Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: early prediction model. Colorectal Dis. 2012;14:e727–34.
    1. Lobo SM, Ronchi LS, Oliveira NE, et al. Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery. Crit Care. 2011;15:R226.
    1. Nygren J, Soop M, Thorell A, et al. An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients. Dis Colon Rectum. 2009;52:978–85.

Source: PubMed

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