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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 the 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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2. Kehlet H, Wilmore DW. Fast-track surgery. Br J Surg 2005;92:3-4.
3. Arumainayagam N, McGrath J, Jefferson KP, Gillatt DA. Introduction of an enhanced recovery protocol for radical cystectomy. BJU Int 2008;101:698-701.
4. Hall TC, Dennison AR, Bilku DK, Metcalfe MS, Garcea G. Enhanced recovery programmes in hepatobiliary and pancreatic surgery: a systematic review. Ann R Coll Surg Engl 2012;94:318-26.
5. Husted H, Troelsen A, Otte K, Kristensen BB, Holm G, Kehlet H. Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg Br 2011;93B:351-6.
6. Muehling B, Schelzig H, Steffen P, Meierhenrich R, Sunder-Plassmann L, Orend KH. A prospective randomized trial comparing traditional and fast-track patient care in elective open infrarenal aneurysm repair. World J Surg 2009;33:577-85.
7. Salhiyyah K, Elsobky S, Raja S, Attia R, Brazier J, Cooper GJ. A clinical and economic evaluation of fast-track recovery after cardiac surgery. Heart Surg Forum 2011;14:E330-4.
8. World Health Organization (2011). Global Health and Aging. In: National Institute on Aging, National Institute of Health, NIH Publication no. 11-7737, October 2011.
9. Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg 2003;238:170-7.
10. Christmas C, Makary MA, Burton JR. Medical considerations in older surgical patients. J Am Coll Surg 2006;203:746-51.
11. Duron JJ, Duron E, Dugue T, Pujol J, Muscari F, Collet D, et al. Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 2011;254:375-82.
12. Neary WD, Heather BP, Earnshaw JJ. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). Br J Surg 2003;90:157-65.
13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205-13.
14. Tejedor P, Pastor C, Gonzalez-Ayora S, Ortega-Lopez M, Guardalajara H, Garcia-Olmo. Short-term outcomes and benefits of ERAS program in elderly patients undergoing colorectal surgery: a case-matched study compared to conventional care. Int J Colorectal Dis 2018;33:1251-8.
15. 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. Colorectal Dis 2014;16:947-56.
16. Kisialeuski M, Pędziwiatr M, Matłok M, Major P, Migaczewski M, Kołodziej D, et al. Enhanced recovery after colorectal surgery in elderly patients. Wideochir Inne Tech Maloinwazyjne 2015;10:30-36.
17. Perrin M, Fletcher A. Laparoscopic abdominal surgery. Contin Educ Anaesth Crit Care Pain 2004;4:107-10.
18. Weber DM. Laparoscopic surgery: an excellent approach in elderly patients. Langenbecks Arch Surg 2004;389:204-8.
19. Chee J, Tan KY. Outcome studies on older patients undergoing surgery are missing the mark. J Am Geriatr Soc 2010;58:2238-40.