Enhanced Recovery After Surgery® (ERAS) in Octogenarians Undergoing HPB Surgery

Abstract

Background: Advances in perioperative care have increased the frequency of surgical intervention performed on the very elderly (≥80 years). This study aims to investigate the impact of Enhanced Recovery After Surgery (ERAS) on outcomes for octogenarians after major hepatopancreatobiliary (HPB) surgery. Methods: Patients ≥ 80 years old in a single HPB ERAS program (September 2015 – July 2018) were prospectively tracked in the Electronic Interactive Audit System (EIAS). Postoperative length of stay (LOS) as well as 30-day major complications, readmissions, and mortality were compared to a pre-ERAS octogenarian control. Results: Since ERAS implementation, octogenarians comprised 7.3% (27 of 370) of patients who underwent pancreaticoduodenectomy (n=17), distal pancreatectomy (n=7), or hepatectomy (n=3). Thirty-day readmissions decreased after ERAS implementation (50% to 15%, p=0.037). Thirty-day major complications, mortality, and LOS were similar with 64% median protocol compliance. Conclusions: ERAS for octogenarians in HPB surgery is safe and may contribute to more sustainable recovery resulting in reduced readmissions.