Colorectal surgery in older patients under ERAS: Outcomes, benefits and implementation barriers

Objectives: It is known that there are significant limitations to implement ERAS (Enhanced Recovery After Surgery) in older patients due to the fact that compliance among all interventions may be difficult to achieve with each patient. The aim of the study was to evaluate the benefits of implementing ERAS protocols in older patients undergoing elective colorectal surgery by assessing compliance with interventions and postoperative outcomes. Methods: A retrospective non-randomised cohort study was conducted over a prospective maintained database initiated at the time of starting a bundle of 10 ERAS interventions in Sept. 2013. We included patients aged ≥70 years undergoing elective colorectal surgery at a tertiary hospital. Outcome measures, compliance with interventions and postoperative complications of patients treated under ERAS were case-matched to a retrospective group of patients aged ≥70 years treated under conventional care. Differences between groups were compared using the Mann Whitney U-test. Categorical data were analyzed using the χ2 test. Results: A total of 313 patients (157 ERAS vs. 156 non-ERAS) were included in the study. The ERAS group had a clinically significant reduction in grade III/IV Dindo-Clavien's postoperative complications when compared with conventional care. ERAS had a positive effect in decreasing anastomotic leakage (14.7% non-ERAS vs. 8.3%; p>0.05) and postoperative mortality (11.5% non-ERAS vs. 5.1% ERAS; p=0.03). A significant reduction of 2 days in LOS was achieved after implementing ERAS, while readmission rates remained unaffected. The average of global compliance (GC) with all ERAS interventions was 45%. GC was significantly lower in patients with stomas and in open surgery cases. Conclusion: In our experience, ERAS should be implemented in older patients undergoing elective colorectal surgery expecting the same goals and benefits than other age groups. Barriers to achieving a high compliance with ERAS in older patients are common and will require a great effort in patient education, intensive perioperative care and sometimes a change in the surgeons’ culture Disclosure of interest: None declared.