Enhanced recovery programs after colorectal surgery in two high-risk populations: elderly patients and after emergency surgery

Abstract

Enhanced recovery programs (ERPs) are multimodal, multidisciplinary perioperative care programs designed to reduce perioperative surgical stress, decrease postoperative morbidity, shorten hospital stay, reduce health care costs, improve patient well-being and satisfaction. ERPs reduce postoperative complications by 50%, resulting in shorter hospital stay. ERPs were later extended to other digestive surgery and surgical specialties with similar results. Recently, ERPs showed a beneficial impact on 5-year survival after colorectal cancer, and on racial disparities. ERPs have also proved useful in some specific high-risk patient populations, such as elderly patients and after emergency colorectal surgery. This work set out to review the EBM literature concerning the feasibility and efficacy of ERP in elderly patients and after emergency colorectal surgery. The results of our RCT comparing a dedicated ERP to non-selected elderly patients after colorectal surgery and our prospective cohort studies are commented in a second in the light of the literature review.