Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Langenbecks Arch Surg. 2020 Aug;405(5):673-689. doi: 10.1007/s00423-020-01930-y. Epub 2020 Jul 8.
Elderly patients with colorectal cancer are high-risk surgical candidates. ERAS protocols have been developed to mitigate against these risks. We performed this study to quantify the risks which elderly patients face and then to determine independent risk factors for short-term ERAS-specific outcomes.
An analysis of a prospectively collected audit database of all patients who underwent elective colorectal cancer resection within an ERAS framework from January 2018 to December 2018 was performed. Elderly was defined in our study as age ≥ 65 years.
There were 172 elective colorectal cancer resections performed. Ninety-seven (56.4%) were elderly. Elderly patients were at increased risk of developing post-operative complications (33.0% vs 16.0%, p = 0.011), longer time to diet (3.4 vs 2.2 days, p = 0.001), and longer hospital stay (10.9 vs 6.7 days, p = 0.007). Independent risk factors were determined for the abovementioned three outcomes. Elderly status was the only risk factor for increased complications (OR 2.61 95% CI (1.05-6.51), p = 0.040). For delayed time to soft diet, male gender (OR 6.67(1.92-20.0), p = 0.002), open approach (OR 9.06(2.26-36.30), p = 0.002), and increased operative time (OR 1.01(1.00-1.01) p = 0.014) were risk factors. Finally, elderly age (OR 5.53(1.82-16.84), p = 0.003), leucocyte count (OR 1.39(0.76-2.57), p = 0.038), open approach (OR 5.26(1.41-19.62), p = 0.013), operative time (OR 1.01(1.00-1.01), p = 0.021), and Clavien-Dindo classification (OR 7.97(1.27-49.88), p = 0.027) were risk factors for prolonged length of stay.
Elderly patients are intrinsically at risk for increased complications, longer time to soft diet and longer hospital stay. ERAS protocols may need to be specifically tailored for elderly patients.
患有结直肠癌的老年患者是高危手术候选者。加速康复外科（ERAS）方案的制定是为了减轻这些风险。我们进行这项研究是为了量化老年患者面临的风险，然后确定短期 ERAS 特定结局的独立危险因素。
对 2018 年 1 月至 2018 年 12 月期间在 ERAS 框架下接受择期结直肠癌切除术的所有患者的前瞻性收集审计数据库进行了分析。在我们的研究中，老年人被定义为年龄≥65 岁。
共进行了 172 例择期结直肠癌切除术。其中 97 例（56.4%）为老年人。老年患者术后并发症的风险增加（33.0%比 16.0%，p=0.011），恢复正常饮食的时间延长（3.4 天比 2.2 天，p=0.001），住院时间延长（10.9 天比 6.7 天，p=0.007）。确定了上述三个结局的独立危险因素。老年是增加并发症的唯一危险因素（OR 2.61，95%CI（1.05-6.51），p=0.040）。对于延迟到软食的时间，男性（OR 6.67（1.92-20.0），p=0.002）、开放手术入路（OR 9.06（2.26-36.30），p=0.002）和手术时间延长（OR 1.01（1.00-1.01），p=0.014）是危险因素。最后，老年（OR 5.53（1.82-16.84），p=0.003）、白细胞计数（OR 1.39（0.76-2.57），p=0.292）、开放手术入路（OR 5.26（1.41-19.62），p=0.013）、手术时间（OR 1.01（1.00-1.01），p=0.021）和 Clavien-Dindo 分级（OR 7.97（1.27-49.88），p=0.027）是延长住院时间的危险因素。
老年患者固有地存在并发症增加、恢复正常饮食时间延长和住院时间延长的风险。ERAS 方案可能需要针对老年患者进行专门定制。
