Gupta Sandhya, Rane Ajay
Department of Obstetrics and Gynaecology, James Cook University, Townsville, Australia.
J Midlife Health. 2021 Apr-Jun;12(2):93-98. doi: 10.4103/jmh.jmh_89_21. Epub 2021 Jul 27.
Enhanced recovery after surgery (ERAS) is a multimodal convention first reported for colorectal and gynecologic procedures. The main benefits have been a shorter length of stay and reduced complications, leading to improved clinical outcomes and cost savings substantially. With increase in life expectancy, recent years has shown a significant rise in advanced age population, and similarly, a rise in age-related disorders requiring surgical management. Due to pathophysiological and metabolic changes in geriatric age group with increased incidence of medical comorbidities, there is higher risk of enhanced surgical stress response with undesirable postoperative morbidity, complications, prolonged immobility, and extended convalescence. The feasibility and effectiveness of ERAS protocols have been well researched and documented among all age groups, including the geriatric high-risk population. Adhering to ERAS protocols after colorectal surgery showed no significant difference in postoperative complications, hospital stay, or readmission rate among various age groups. A recent report mentions the safety and benefits following ERAS guidelines with reduced length of stay in elderly patients with short-level lumbar fusion surgery. The concept of prehabilitation has evolved as an integral part of ERAS to build up physiological reserve, especially in geriatric high-risk group, and to adapt better to surgical stress. High levels of compliance with ERAS interventions combined with prehabilitation can be achieved when a dedicated multidisciplinary team is involved in care of these high-risk patients.
术后加速康复(ERAS)是一种多模式方案,最初是针对结直肠和妇科手术报道的。其主要益处包括缩短住院时间和减少并发症,从而显著改善临床结局并节省成本。随着预期寿命的增加,近年来老年人口显著增加,同样,需要手术治疗的与年龄相关的疾病也有所增加。由于老年人群存在病理生理和代谢变化,且合并症发生率增加,手术应激反应增强的风险更高,术后会出现不良发病率、并发症、长期制动和康复期延长。ERAS方案在包括老年高危人群在内的所有年龄组中的可行性和有效性已得到充分研究和记录。结直肠手术后遵循ERAS方案,各年龄组在术后并发症、住院时间或再入院率方面无显著差异。最近一份报告提到,老年患者进行短节段腰椎融合手术时,遵循ERAS指南具有安全性和益处,可缩短住院时间。术前康复的概念已演变为ERAS的一个组成部分,以建立生理储备,特别是在老年高危人群中,并更好地适应手术应激。当一个专门的多学科团队参与这些高危患者的护理时,可以实现对ERAS干预措施的高度依从性并结合术前康复。