Department of Thoracic Surgery, AOS Croce e Carle, Cuneo, Italy.
, Via Trincee 4/11, 17100, Savona, Italy.
Gen Thorac Cardiovasc Surg. 2020 Sep;68(9):1003-1010. doi: 10.1007/s11748-020-01331-4. Epub 2020 Mar 12.
To evaluate whether ERAS is feasible and beneficial in elderly patients undergoing VATS lobectomy for lung cancer.
From February 2016 to March 2019, 182 patients were included into a 17-items ERAS pathway. Patients were divided into two groups according to age: Group A (< 75 years) 138 patients and Group B (≥ 75 years) 44 patients. End points were: length of stay (LoS), 30-day morbidity, 90-day mortality, 30-day re-admittance rate, and ERAS-score (number of ERAS objectives achieved).
Elderly patients had significantly more chronic renal failure (p = 0.039) and a worse pulmonary function. Mean FEV1% was 101.6% (± 21.0% SD) and 90.8% (± 19.1% SD) and mean FEV1/FVC was 0.75 (± 0.10 SD) and 0.68 (± 0.12 SD) for group A and B, respectively (p = 0.02 and p = 0.01). Median LoS was longer in Group B (6 days) than in Group A (5 days; p = 0.006). Morbidity was higher for elderly patients (A 32.6% vs B 56.8%; p = 0.007), major complication rates were similar (p = 0.782). No post-operative mortality was observed, re-admittance rates were similar (A 7.8% vs B 11.5%; p = 0.548). Mean ERAS-scores were 13.8 (± 1.83 SD) for Group A and 13.4 (± 1.98 SD) for Group B (p = 0.240). Multivariable analysis showed previous major surgery (p = 0.028), COPD (p = 0.027), history of arrhythmic disease (p = 0.015), post-operative complications (p < 0.001), and ERAS-score (p < 0.001) as independent predictive factors of LoS, age did not significantly influence LoS.
Elderly patients adhere to an ERAS protocol similarly to younger ones. ERAS pathway in VATS lobectomy patients seems to be beneficial regardless the age.
评估加速康复外科（ERAS）方案在接受电视辅助胸腔镜手术（VATS）肺叶切除术的老年肺癌患者中的可行性和益处。
从 2016 年 2 月至 2019 年 3 月，共有 182 例患者纳入了 17 项 ERAS 路径。根据年龄将患者分为两组：A 组（<75 岁）138 例和 B 组（≥75 岁）44 例。终点为：住院时间（LoS）、30 天发病率、90 天死亡率、30 天再入院率和 ERAS 评分（ERAS 目标实现数量）。
老年患者慢性肾衰竭（p=0.039）和肺功能更差的发生率显著更高。A 组的平均 FEV1%为 101.6%（±21.0% SD），B 组为 90.8%（±19.1% SD），A 组的平均 FEV1/FVC 为 0.75（±0.10 SD），B 组为 0.68（±0.12 SD）（p=0.02 和 p=0.01）。B 组（6 天）的中位 LoS 长于 A 组（5 天；p=0.006）。老年患者的发病率更高（A 组为 32.6%，B 组为 56.8%；p=0.007），但主要并发症发生率相似（p=0.782）。无术后死亡，再入院率相似（A 组为 7.8%，B 组为 11.5%；p=0.548）。A 组的平均 ERAS 评分（±1.83 SD）为 13.8，B 组为 13.4（±1.98 SD）（p=0.240）。多变量分析显示，既往大手术（p=0.028）、COPD（p=0.027）、心律失常病史（p=0.015）、术后并发症（p<0.001）和 ERAS 评分（p<0.001）是 LoS 的独立预测因素，而年龄并未显著影响 LoS。
老年患者与年轻患者一样，也能严格遵循 ERAS 方案。在 VATS 肺叶切除术中，无论年龄大小，ERAS 路径似乎都有益处。
