General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Rome, Italy -
Institute of General Surgery, Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
Minerva Chir. 2020 Jun;75(3):157-163. doi: 10.23736/S0026-4733.20.08275-9. Epub 2020 Feb 20.
It is still unknown whether ERAS program is safe, feasible and effective in elderly patients undergoing laparoscopic colorectal surgery. In addition, the definition of the "old patient" in terms of age varies across the studies and different age cut-off, such as 65, 70, and 75 years have been used worldwide.
All adult patients undergoing primary, elective colorectal laparoscopic surgery between January 2017 and December 2018 were considered eligible to follow the ERAS protocol according to the Enhanced Recovery After Surgery (ERAS) Society guidelines. Elderly were defined according three different cut-off values: <65 and ≥65 years, <70 and ≥70 years, <75 and ≥75 years.
One hundred and eight patients were included in the study. Adherence to protocol did not differ significantly between younger and older patients, for most of the items. Thirty-day mortality was absent. The frequency of postoperative complications globally considered and the frequency of the various single complications did not differ significantly between younger and older patients, independently of the cutoff considered to define the older age. Similarly, the frequency of re-intervention and readmission was similar in younger and older patients. Time to flatus and time to stool were similar in young and older patients, independently of the age cut-off used. Time to oral liquid diet was similar in patients with age <65 and ≥65 years while it was moderately longer in patients ≥70 years (1.5±1.1 days;) than in those <70 years (1.1±0.4 days; P=0.030) as well as in patients ≥75 years with respect to the younger ones (1.2±0.5 vs. 1.6±1.2 days; P=0.045). The time to oral solid feeding was similar in young and old patients, independently of the age cut-off used. Time to bladder catheter removal was significantly longer in older patients, independently of the age cut-off used, although the differences do not seem to be clinically relevant. The length of stay was significantly higher in older patients, when the cutoff of 70 years or 75 years was used, but did not differ significantly when the cut-off of 65 years was used.
The present study shows that the ERAS protocol is safe, feasible, and effective in elderly patients as in the young ones, undergoing laparoscopic elective colorectal surgery. This suggests that the ERAS program can be applied usefully to elderly patients in the routine clinical practice.
在接受腹腔镜结直肠手术的老年患者中，加速康复外科（ERAS）方案是否安全、可行和有效仍不清楚。此外，关于年龄的“老年患者”的定义在不同的研究中有所不同，并且使用了不同的年龄截止值，例如 65、70 和 75 岁。
根据增强康复术后（ERAS）协会指南，所有在 2017 年 1 月至 2018 年 12 月期间接受原发性、择期腹腔镜结直肠手术的成年患者均被认为符合 ERAS 方案。老年人根据三个不同的截止值进行定义：<65 岁和≥65 岁、<70 岁和≥70 岁、<75 岁和≥75 岁。
研究共纳入 108 例患者。对于大多数项目，年轻患者和老年患者在遵守方案方面没有显著差异。术后 30 天内无死亡病例。全球考虑的术后并发症发生率和各种单一并发症的发生率在年轻患者和老年患者之间没有显著差异，与用于定义老年的截止值无关。同样，年轻患者和老年患者的再干预和再入院率相似。年轻患者和老年患者的肠鸣音时间和排便时间相似，与使用的年龄截止值无关。年龄<65 岁和≥65 岁的患者与年龄<70 岁的患者相比，开始口服液体饮食的时间相似（1.5±1.1 天）；但与年龄≥70 岁的患者相比（1.2±0.5 天），时间更长（1.1±0.4 天；P=0.030）；与年轻患者相比，年龄≥75 岁的患者也更长（1.2±0.5 天 vs. 1.6±1.2 天；P=0.045）。年轻患者和老年患者的口服固体饮食时间相似，与使用的年龄截止值无关。老年患者的导尿管拔除时间明显延长，与使用的年龄截止值无关，但当使用 65 岁截止值时，差异无统计学意义。住院时间在年龄较大的患者中明显较高，当使用 70 岁或 75 岁的截止值时，但当使用 65 岁的截止值时，差异无统计学意义。
本研究表明，在接受腹腔镜择期结直肠手术的老年患者中，ERAS 方案与年轻患者一样安全、可行、有效。这表明 ERAS 方案可在常规临床实践中有效地应用于老年患者。
