Ann Coloproctol.  2022 Feb;38(1):47-52. 10.3393/ac.2021.00283.0040.

Clinical validation of implementing Enhanced Recovery After Surgery protocol in elderly colorectal cancer patients

• Koh W
• Lee CS
• Bae JH
• Al-Sawat A
• Lee IK
• Jin HY

• KMID: 2526566
• DOI: http://doi.org/10.3393/ac.2021.00283.0040

Abstract

Purpose
The aim of this study was to evaluate the safety and feasibility of applying enhanced recovery after surgery (ERAS) protocol in elderly colorectal cancer patients.
Methods
The medical records of patients who underwent elective colorectal cancer surgery at our institution, from January 2017 to December 2017, were reviewed. Patients were divided into 2 groups: the young group (YG, patients aged 70 and under 70 years) and the old group (OG, patients over 70 years old). Perioperative outcomes and length of hospital stay were compared between both groups.
Results
In total, 335 patients were enrolled; 237 were YG and 98 were OG. Despite the poorer baseline characteristics of OG, the perioperative outcomes were similar. Length of hospital stay was not different between the groups (YG, 5 days vs. OG, 5 days; P=0.320). When comparing the postoperative complications using the comprehensive complication index (CCI), there was no significant difference (YG, 8.0±13.2 vs. OG, 11.7±23.0; P=0.130). In regression analysis, old age (>70 years) was not a risk factor for high CCI in all patients. In multivariate analysis, C-reactive protein (CRP) level on postoperative day (POD) 3 to 4 was the only strong predictive factor for high CCI in elderly patients.
Conclusion
Implementing the ERAS protocol in patients aged >70 years is safe and feasible. High CRP (≥6.47 mg/dL) on POD 3 to 4 can be used as a safety index to postpone discharge in elderly patients.

Keyword

Aged; Enhanced recovery after surgery; Colorectal neoplasms; Morbidity