A retrospective observational study of enhanced recovery after surgery in older patients undergoing elective colorectal surgery.

Katleen Fagard,Mieke Deschodt,Marleen Verhaegen,Albert Wolthuis,Johan Flamaing,Yan Li

doi:10.1371/journal.pone.0232857

Katleen Fagard, Mieke Deschodt + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0232857

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Journal: PloS one	Publication Date: May 8, 2020
Citations: 3	License type: CC BY 4.0

Affiliation: University of Basel, KU Leuven

Abstract

Enhanced recovery programs (ERPs) in colorectal surgery have demonstrated beneficial effects on postoperative complications, return of bowel function, length of stay, and costs, without increasing readmissions or mortality. However, ERPs were not specifically designed for older patients and feasibility in older patients has been questioned. The aim of this study was to assess ERP adherence and outcomes in older patients and to identify risk factors for postoperative complications and prolonged length of stay. Retrospective analysis of consecutive patients (≥70 years) undergoing elective colorectal resection in a tertiary referral hospital in 2017. Ninety-six patients were included. Adherence rates were above 80% in 18 of 21 ERP interventions considered. The lowest adherence rates were noted for preoperative carbohydrate loading and cessation of intravenous fluids. Postoperative complications (Clavien-Dindo ≥2) and prolonged postoperative length of stay (>75th percentile) were observed in 39.6% and 26.3%, respectively. Median length of stay was 7 days. The 30-day mortality, readmission and reoperation rates were 2.1%, 12.6% and 8.3%, respectively. Multivariable analysis indicated that polypharmacy and site of surgery were independent risk factors for postoperative complications, while higher age, American Society of Anesthesiologists class and preoperative radiotherapy were independent risk factors for prolonged postoperative length of stay. ERP adherence in older patients undergoing colorectal resection is high and ERP is therefore considered feasible. Postoperative complications and prolonged postoperative length of stay are common, so at risk patients should be targeted with tailored geriatric interventions.

Highlights

Population growth, demographic ageing and advances in surgical and anesthetic techniques have caused a marked increase in the demand for surgical procedures in older persons [1,2,3]
The lowest adherence rates were noted for preoperative carbohydrate loading and cessation of intravenous fluids
Postoperative complications and prolonged postoperative length of stay are common, so at risk patients should be targeted with tailored geriatric interventions

Summary

Introduction

Population growth, demographic ageing and advances in surgical and anesthetic techniques have caused a marked increase in the demand for surgical procedures in older persons [1,2,3]. As ageing is associated with a decrease in physiologic reserve and higher rates of comorbidity, many older patients are more susceptible to adverse postoperative outcomes, such as medical and surgical complications, prolonged hospital stay, loss of independence in activities of daily living, and need for institutionalization. This presents organizational and socio-economic challenges to our health care system [3,4,5,6]. Enhanced recovery programs (ERPs) in colorectal surgery have demonstrated beneficial effects on postoperative complications, return of bowel function, length of stay, and costs, without increasing readmissions or mortality. ERPs were not designed for older patients and feasibility in older patients has been questioned

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