Compliance with enhanced recovery protocols in elderly patients undergoing colorectal resection

Introduction Enhanced recovery after surgery (ERAS) is associated with reduced length of stay (LOS) and improved outcomes in colorectal surgery. It is unclear whether ERAS can be safely implemented in elderly patients undergoing complex colorectal resections. The aim of this study was to evaluate th...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2018-09, Vol.100 (7), p.570-579
Main Authors: Hallam, S, Rickard, F, Reeves, N, Messenger, D, Shabbir, J
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Colorectal Neoplasms - mortality
Colorectal Neoplasms - surgery
Colorectal Surgery
Databases, Factual
Digestive System Surgical Procedures - adverse effects
Digestive System Surgical Procedures - standards
Digestive System Surgical Procedures - statistics & numerical data
Feasibility Studies
Female
Guideline Adherence - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Patient Readmission - statistics & numerical data
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Prospective Studies
Recovery of Function
Reoperation - statistics & numerical data
Risk Factors
Survival Rate
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Summary:Introduction Enhanced recovery after surgery (ERAS) is associated with reduced length of stay (LOS) and improved outcomes in colorectal surgery. It is unclear whether ERAS can be safely implemented in elderly patients undergoing complex colorectal resections. The aim of this study was to evaluate the feasibility of ERAS in patients of all ages undergoing colorectal surgery. Methods A prospective database of a consecutive series of patients undergoing colorectal resections with ERAS between August 2012 and December 2014 was evaluated. Patients were divided into four age groups. Outcomes studied were compliance with ERAS elements, LOS, morbidity and mortality. Results Of the 294 patients in the study cohort, 79 were 6 days) or morbidity. Factors that were predictive of delayed discharge on multivariate analysis were open surgery (odds ratio [OR]: 2.23, p=0.003), conversion to open surgery (OR: 3.23, p=0.017), stoma formation (OR: 2.10, p=0.019) and chronic obstructive pulmonary disease (OR: 4.12, p=0.038). Factors predictive of morbidity on multivariate analysis comprised conversion to open surgery (OR: 7.72, p=0.004), high creatinine (OR: 1.03 per unit increase in creatinine, p=0.008) and stoma education (OR: 0.31, p=0.030). Conclusions ERAS can be successfully implemented in older patients. There was equal compliance with the ERAS programme across the four age groups and no significant effect of age on LOS or morbidity.
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2018.0102