Compliance with Guidelines of Enhanced Recovery After Surgery in Elderly Patients Undergoing Gastrectomy

Enhanced recovery after surgery (ERAS) aims at expediting postoperative recovery by implementing specific strategies in perioperative management. However, the tolerance to such fast-tracking protocols is under debate, especially in elderly patients. We aimed to investigate rate of compliance with the main ERAS guidelines in elderly gastrectomy patients.

Using data for 168 gastric cancer patients who underwent ERAS after gastrectomy as part of Clinical Trial NCT01653496, we calculated the rates of compliance with nine main ERAS guidelines and compared the compliance rates of elderly (≥70 years) and non-elderly (<70 years) patients. Surgical outcomes and fulfillment of criteria for postoperative discharge were also compared.

The study included 55 elderly and 113 non-elderly patients. There were no significant differences between these groups of patients with respect to operative techniques and tumor stage. Except for restricted intravenous fluid administration, the patients in both groups showed very high compliance rates (>90%) for every ERAS guideline. Notably, the overall compliance rates did not differ significantly between the groups. Postoperatively, the mean time to fulfillment of discharge criteria was slightly longer for elderly patients (4.7 vs. 4.2 days, p = 0.005), but there were no significant differences between the groups with respect to the incidence of postoperative complications, length of hospitalization, and readmission rate.

Compliance of the medically and physically fit elderly patients with the main ERAS guidelines is comparable to that of non-elderly patients, and such protocols can be safely applied to elderly patients without significant modification.