Koh Wooree, Lee Chul Seung, Bae Jung Hoon, Al-Sawat Abdullah, Lee In Kyu, Jin Hyeong Yong
Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia.
Ann Coloproctol. 2022 Feb;38(1):47-52. doi: 10.3393/ac.2021.00283.0040. Epub 2021 Jul 21.
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.
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.
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.
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.
本研究旨在评估在老年结直肠癌患者中应用术后加速康复（ERAS）方案的安全性和可行性。
回顾了2017年1月至2017年12月在我院接受择期结直肠癌手术患者的病历。患者分为两组：年轻组（YG，年龄70岁及以下的患者）和老年组（OG，年龄超过70岁的患者）。比较两组的围手术期结局和住院时间。
共纳入335例患者；237例为YG组，98例为OG组。尽管OG组患者的基线特征较差，但围手术期结局相似。两组的住院时间无差异（YG组为5天，OG组为5天；P = 0.320）。使用综合并发症指数（CCI）比较术后并发症时，无显著差异（YG组为8.0±13.2，OG组为11.7±23.0；P = 0.130）。在回归分析中，高龄（>70岁）并非所有患者高CCI的危险因素。在多变量分析中，术后第3至4天的C反应蛋白（CRP）水平是老年患者高CCI的唯一强预测因素。
在70岁以上患者中实施ERAS方案是安全可行的。术后第3至4天的高CRP（≥6.47mg/dL）可作为老年患者延迟出院的安全指标。
