Braga Marco, Beretta Luigi, Pecorelli Nicolò, Maspero Marianna, Casiraghi Umberto, Borghi Felice, Pellegrino Luca, Bona Stefano, Monzani Roberta, Ferrari Gianluigi, Radrizzani Danilo, Iuliani Riccardo, Bima Carlo, Scatizzi Marco, Missana Giancarlo, Guicciardi Marco Azzola, Muratore Andrea, Crespi Michele, Bouzari Hedayat, Ceretti Andrea Pisani, Ficari Ferdinando
Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Milan, Italy.
Updates Surg. 2018 Mar;70(1):7-13. doi: 10.1007/s13304-017-0474-4. Epub 2017 Jun 15.
Previous studies reported that enhanced recovery pathway (ERP) is safe in elderly who did not require a specifically tailored protocol. In previous studies, elderly have been considered as a homogeneous cohort and the cut-off value to identify them was different. The aim of the present study is to assess the compliance to ERP and its impact on postoperative outcome in three subgroups of elderly patients with increasing ages. Prospectively collected data entered in an electronic Italian registry specifically designed for ERP were reviewed. 315 elderly patients undergoing elective colorectal resection were divided into three groups. Group 1: 71-75 years (n = 105), Group 2: 76-80 years (n = 117), Group 3: over 80 years (n = 93). Primary endpoints of the study were adherence to ERP and time to readiness for discharge (TRD). Compliance to ERP was similar in the three groups. No difference among groups was found for mortality, overall morbidity, major complications, reoperation rate and readmission rate. Median TRD and length of hospital stay (LOS) were progressively longer with increasing age (p = 0.018 and p = 0.078, respectively). Increasing age did not impact on adherence to ERP and postoperative morbidity, but delayed both TRD and LOS.
以往研究报告称，对于无需特别定制方案的老年人，强化康复路径（ERP）是安全的。在以往研究中，老年人被视为一个同质化队列，且识别他们的临界值有所不同。本研究的目的是评估年龄渐长的三组老年患者对ERP的依从性及其对术后结局的影响。回顾了前瞻性收集并录入专门为ERP设计的意大利电子登记系统的数据。315例行择期结直肠切除术的老年患者被分为三组。第1组：71 - 75岁（n = 105），第2组：76 - 80岁（n = 117），第3组：80岁以上（n = 93）。该研究的主要终点是对ERP的依从性和出院准备时间（TRD）。三组对ERP的依从性相似。在死亡率、总体发病率、主要并发症、再次手术率和再入院率方面，各组之间未发现差异。随着年龄增长，TRD中位数和住院时间（LOS）逐渐延长（分别为p = 0.018和p = 0.078）。年龄增长并未影响对ERP的依从性和术后发病率，但延迟了TRD和LOS。
