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Randomized Controlled Trial of Enhanced Recovery Program Dedicated to Elderly Patients After Colorectal Surgery
Sandrine Ostermann1,2, Philippe Morel1, Jean-Jacques Chalé3
1Visceral Surgery, Department of Surgery, University Hospital Geneva, Geneva, Switzerland.
Diseases of the Colon and Rectum
|July 19, 2019
Summary
Enhanced recovery programs significantly reduce postoperative morbidity and hospital stays for elderly patients undergoing colorectal surgery. This evidence-based approach improves recovery, making it a recommended standard of care for this demographic.
Area of Science:
- Geriatric Surgery
- Colorectal Surgery
- Evidence-Based Medicine
Background:
- Enhanced recovery programs (ERPs) are multimodal, evidence-based care strategies designed to minimize surgical stress, reduce complications, and shorten hospital stays.
- While ERPs show promise for elderly patients (≥70 years), research specifically investigating their efficacy in this population is limited.
Purpose of the Study:
- To evaluate the feasibility and efficiency of a dedicated enhanced recovery program for elderly patients undergoing elective colorectal surgery.
- To compare the outcomes of ERP with standard perioperative care in this patient group.
Main Methods:
- A nonblinded, randomized controlled study was conducted at a single, high-volume university hospital.
- 150 elderly patients (≥70 years) undergoing elective colorectal surgery were randomized to either an enhanced recovery program or standard care.
- Primary outcome was 30-day postoperative morbidity; secondary outcomes included hospital stay, readmission rates, pain, opioid consumption, independence preservation, and protocol compliance.
Main Results:
- The enhanced recovery program significantly reduced 30-day postoperative morbidity by 47% (35% vs. 65%, p=0.0003) and the total number of complications (54 vs. 118, p=0.0003).
- Anastomotic leaks were eliminated in the ERP group compared to 5 in the standard care group (p=0.01).
- ERP led to a shorter hospital stay (7 vs. 12 days, p=0.003) and improved independence preservation (87% vs. 67% home discharge, p=0.005), with high protocol compliance (77.2%).
Conclusions:
- Enhanced recovery programs are safe and effective for elderly patients undergoing elective colorectal surgery.
- ERPs lead to decreased morbidity, shorter hospital stays, and better maintenance of patient independence.
- These findings support the consideration of enhanced recovery programs as a standard of care for elderly patients undergoing colorectal surgery.
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