S. Eugenio Hospital, Rome, Italy.
Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.
Langenbecks Arch Surg. 2022 Nov;407(7):3079-3088. doi: 10.1007/s00423-022-02580-y. Epub 2022 Jun 14.
The aim of this study was to evaluate the safety and compliance with the enhanced recovery after surgery (ERAS) protocol in octogenarian patients undergoing colorectal surgery in 12 Italian high-volume centers.
A retrospective analysis was conducted in a consecutive series of patients who underwent elective colorectal surgery between 2016 and 2018. Patients were grouped by age (≥ 80 years vs < 80 years), propensity score matching (PSM) analysis was performed, and the groups were compared regarding clinical outcomes and the mean number of ERAS items applied.
Out of 1646 patients identified, 310 were octogenarians. PSM identified 2 cohorts of 125 patients for the comparison of postoperative outcomes and ERAS compliance. The 2 groups were homogeneous regarding the clinical variables and mean number of ERAS items applied (11.3 vs 11.9, p-ns); however, the application of intraoperative items was greater in nonelderly patients (p 0.004). The functional recovery was similar between the two groups, as were the rates of postoperative severe complications and 30-day mortality rate. Elderly patients had more overall complications. Furthermore, the mean hospital stay was higher in the elderly group (p 0.027). Multivariable analyses documented that postoperative stay was inversely correlated with the number of ERAS items applied (p < 0.0001), whereas age ≥ 80 years significantly correlated with the overall complication rate (p 0.0419).
The ERAS protocol is safe in octogenarian patients, with similar levels of compliance and surgical outcomes. However, octogenarian patients have a higher rate of overall complications and a longer hospital stay than do younger patients.
本研究旨在评估 12 家意大利高容量中心 80 岁以上行结直肠手术患者的术后加速康复（ERAS）方案的安全性和依从性。
对 2016 年至 2018 年间择期行结直肠手术的连续系列患者进行回顾性分析。根据年龄（≥80 岁与<80 岁）分组，行倾向评分匹配（PSM）分析，并比较两组患者的临床结局和 ERAS 项目的平均应用数量。
在确定的 1646 例患者中，有 310 例为 80 岁以上的患者。PSM 确定了两组 125 例患者，以比较术后结局和 ERAS 依从性。两组患者的临床变量和 ERAS 项目平均应用数量均相似（11.3 对 11.9，p-ns）；然而，非老年患者术中项目的应用更多（p 0.004）。两组患者的功能恢复相似，术后严重并发症发生率和 30 天死亡率也相似。老年患者的总体并发症更多。此外，老年组的平均住院时间更高（p 0.027）。多变量分析记录到术后住院时间与 ERAS 项目应用数量呈负相关（p<0.0001），而年龄≥80 岁与总体并发症发生率显著相关（p 0.0419）。
ERAS 方案在 80 岁以上患者中是安全的，其依从性和手术结局相似。然而，80 岁以上患者的总体并发症发生率和住院时间均高于年轻患者。
