Dalsgaard Elna A, Dolin Troels G, Lund Cecilia M, Lykke Jakob, Munk Tina, Vinther Anders, Rosenberg Jacob
Centre for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark; Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.
Geriatric Research and Clinical Evidence (GRACE), Department of Internal Medicine Geriatric Section, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.
J Geriatr Oncol. 2025 Sep;16(7):102289. doi: 10.1016/j.jgo.2025.102289. Epub 2025 Jun 23.
The incidence of colon cancer increases with age, and the primary treatment is surgical resection. Patients with frailty have a reduced ability to handle stressors and face a higher risk of complications and poor recovery after surgery. While Enhanced Recovery After Surgery (ERAS®) pathways improve in-hospital recovery, readmission rates remain high, and no structured post-discharge interventions exist for this population. Home-based post-discharge support may further enhance recovery in patients with frailty. This study evaluates the effect of an ERAS® 3.0 programme incorporating home-based geriatric, nutritional, and exercise interventions after discharge.
This randomized controlled trial includes patients with colon cancer undergoing elective colonic resection within the ERAS® pathway during hospitalization. Patients with frailty (Clinical Frailty Scale score 4-7) and at nutritional risk (Nutritional Risk Screening 2002 ≥ 3) will be randomized 1:1 to either the intervention group (home-based geriatric, nutritional, and exercise interventions after discharge, n = 30) or standard post-discharge care (n = 30). The ERAS® 3.0 intervention includes protein-enriched foods and drinks at discharge, home-based comprehensive geriatric assessment, dietary counselling and exercise instructions, and outpatient follow-up with dietary counselling. The primary outcome is change in the Quality of Recovery-15 score from baseline to 12 ± 2 days after surgery. Secondary outcomes include quality of life, activities of daily living, energy and protein intake, appetite, 30-s chair-stand-test, muscle mass, total length of hospital stay, readmission rate, postoperative complications occurring after discharge, mortality, and costs.
This study extends the ERAS® principles beyond hospitalization, addressing the post-discharge needs of patients with frailty at nutritional risk following colon cancer surgery. While ERAS® protocols significantly improve in-hospital recovery, readmission rates remain high and structured post-discharge interventions are lacking. By incorporating home-based geriatric, nutritional, and exercise interventions, this study aims to reduce complications, improve functional recovery, and quality of life. A key strength is the use of patient-reported outcome measures, providing an assessment of recovery beyond traditional clinical metrics. If effective, the ERAS® 3.0 intervention could offer a strategy for optimizing post-discharge care for surgical patients with frailty.
结肠癌的发病率随年龄增长而增加，主要治疗方法是手术切除。体弱患者应对压力源的能力下降，术后面临更高的并发症风险和恢复不佳的风险。虽然术后加速康复（ERAS®）路径可改善住院期间的恢复情况，但再入院率仍然很高，且针对该人群没有结构化的出院后干预措施。基于家庭的出院后支持可能会进一步促进体弱患者的恢复。本研究评估了一项包含出院后基于家庭的老年护理、营养和运动干预的ERAS® 3.0计划的效果。
这项随机对照试验纳入了在住院期间按照ERAS®路径接受择期结肠切除术的结肠癌患者。体弱（临床衰弱量表评分为4 - 7分）且有营养风险（营养风险筛查2002≥3）的患者将按1:1随机分为干预组（出院后基于家庭的老年护理、营养和运动干预，n = 30）或标准出院后护理组（n = 30）。ERAS® 3.0干预包括出院时富含蛋白质的食物和饮料、基于家庭的全面老年评估、饮食咨询和运动指导，以及门诊饮食咨询随访。主要结局是术后12±2天恢复质量-15评分相对于基线的变化。次要结局包括生活质量、日常生活活动能力、能量和蛋白质摄入量、食欲、30秒坐立试验、肌肉量、住院总时长、再入院率、出院后发生的术后并发症、死亡率和费用。
本研究将ERAS®原则扩展到住院期之外，解决了结肠癌手术后有营养风险的体弱患者的出院后需求。虽然ERAS®方案显著改善了住院期间的恢复情况，但再入院率仍然很高且缺乏结构化的出院后干预措施。通过纳入基于家庭的老年护理、营养和运动干预，本研究旨在减少并发症、改善功能恢复和生活质量。一个关键优势是使用了患者报告的结局指标，提供了超越传统临床指标的恢复评估。如果有效，ERAS® 3.0干预可为优化体弱手术患者的出院后护理提供一种策略。
