Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2019; 11(10): 395-406
Published online Oct 27, 2019. doi: 10.4240/wjgs.v11.i10.395
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
Corrado Pedrazzani, Cristian Conti, Giulia Turri, Enrico Lazzarini, Marzia Tripepi, Giovanni Scotton, Matteo Rivelli, Alfredo Guglielmi, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy
Author contributions: Pedrazzani C, Conti C and Guglielmi A designed the research; Rivelli M, Lazzarini E and Scotton G performed the research; Pedrazzani C and Turri G analysed the data; Conti C wrote the paper; Pedrazzani C, Tripepi M and Guglielmi A critically revised the manuscript for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of University of Verona, Verona, Italy, with ID number: 53538.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest.
Data sharing statement: Deidentified participant data from prospectively collected database are available upon reasonable request to the corresponding author.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement - checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Corrado Pedrazzani, MD, Associate Professor, Surgeon, Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Piazzale “L. Scuro” 10, Verona 37134, Italy. corrado.pedrazzani@univr.it
Telephone: +39-45-8126719 Fax: +39-45-8027426
Received: April 19, 2019
Peer-review started: April 19, 2019
First decision: August 2, 2019
Revised: October 14, 2019
Accepted: October 18, 2019
Article in press: October 18, 2019
Published online: October 27, 2019
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: Colorectal surgery, Laparoscopic surgery, Enhanced recovery protocol, Age, Elderly

Core tip: Feasibility and safety of enhanced recovery protocols in elderly populations undergoing minimally invasive colorectal surgery have been questioned by recent literature. Age has been considered an obstacle for enhanced recovery and a risk factor for surgical outcomes. Our study investigated the impact of age on fast-track after laparoscopic colorectal resection. Early removal of urinary catheter and walking resumption were the most difficult goals achieved by the elderly. Nevertheless, general compliance to fast-track items was good and, although discharge criteria were fulfilled later in older patients, no differences in length of stay and major complications rate were observed.