Key result
In older patients undergoing elective colorectal resection in an enhanced recovery program, Clavien-Dindo ≥2 complications occurred in 39.6%, with polypharmacy as an independent risk factor.
Why the study?
Enhanced recovery programs were not specifically designed for older patients, and their feasibility in this population has been questioned.
Observational (n=96)
No
Enhanced recovery programs are feasible and have high adherence in older patients undergoing colorectal surgery, though postoperative complications and prolonged length of stay remain common, suggesting a need for tailored geriatric interventions.
High ERP adherence supports feasibility in older colorectal patients; leaves open whether targeted geriatric interventions reduce complications.
BACKGROUND: 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. AIM: 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. METHOD: Retrospective analysis of consecutive patients (≥70 years) undergoing elective colorectal resection in a tertiary referral hospital in 2017. RESULTS: 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. CONCLUSION: 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.
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Fagard et al. (2020) conducted an observational in Elective colorectal resection (n=96). Enhanced recovery program (ERP) was evaluated on Clavien-Dindo ≥2 in-hospital postoperative complications. In older patients undergoing elective colorectal resection in an enhanced recovery program, Clavien-Dindo ≥2 complications occurred in 39.6%, with polypharmacy as an independent risk factor.
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