Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection

Corrado Pedrazzani; Cristian Conti; Giulia Turri; Enrico Lazzarini; Marzia Tripepi; Giovanni Scotton; Matteo Rivelli; Alfredo Guglielmi

doi:10.4240/wjgs.v11.i10.395

Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection

World J Gastrointest Surg. 2019 Oct 27;11(10):395-406. doi: 10.4240/wjgs.v11.i10.395.

Authors

Corrado Pedrazzani¹, Cristian Conti², Giulia Turri², Enrico Lazzarini², Marzia Tripepi², Giovanni Scotton², Matteo Rivelli², Alfredo Guglielmi²

Affiliations

¹ Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy. corrado.pedrazzani@univr.it.
² Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy.

Abstract

Background: There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.

Aim: To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol (ERP) after laparoscopic colorectal resection.

Methods: Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed. Three groups were considered according to patients' age: Group A, 65 years old or less, Group B, 66 to 75 years old and Group C, 76 years old or more. Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications, mortality and readmission rate. Differences in post-operative length of stay and adherence to ERP's items were evaluated in the three study groups.

Results: Among the 225 patients, 112 belonged to Group A, 57 to Group B and 56 to Group C. Thirty-day overall morbidity was 32.9% whilst mortality was nihil. Though the percentage of complications progressively increased with age (25.9% vs 36.8% vs 42.9%), no differences were observed in the rate of major complications (4.5% vs 3.5% vs 1.8%), prolonged post-operative ileus (6.2% vs 12.2% vs 10.7%) and anastomotic leak (2.7% vs 1.8% vs 1.8%). Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal (P = 0.032) and autonomous deambulation (P = 0.013) in elderly patients. Although discharge criteria were achieved later in older patients (3 d vs 3 d vs 4 d, P = 0.040), post-operative length of stay was similar in the 3 groups (5 d vs 6 d vs 6 d).

Conclusion: ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.

Keywords: Age; Colorectal surgery; Elderly; Enhanced recovery protocol; Laparoscopic surgery.