Impact of an enhanced recovery after surgery program on outcomes in elderly patients undergoing open gynecologic...

To compare post-operative outcomes and compliance with enhanced recovery after surgery (ERAS) protocol in matched older (≥65) and younger (<65) patients undergoing open gynecologic cancer surgery.

This is a retrospective, single-institution analysis comparing post-operative outcomes between patients <65 years old and ≥65 years old who underwent laparotomy for suspected malignant gynecologic tumors from November 2014 to December 2023 at MD Anderson Cancer Center under ERAS protocols. Patients were excluded if they underwent a pelvic exenteration, multiteam surgery, or did not have a gynecologic primary tumor. Propensity score matching was used to match older and younger patients by year, disease status, disease site, and surgical complexity score.

A total of 1430 patients were included in the study, with 715 patients in each group (<65 years and ≥65 years). The median age was 52 years in the younger group and 70 years in the older group. The distribution of length of stay differed significantly between the age groups. The majority of patients in both groups had malignant disease (84.4%). There were no differences in post-operative complications (p = .37), readmission (6% vs 6%, p = .94), or reoperation (0.8% vs 1.2%, p = .58) rates between groups. Overall compliance differed significantly between the 2 groups. Younger patients had a median overall compliance of 75% (interquartile range; 70%-75%) compared to 75% (interquartile range; 70%-80%) among older patients (p < .001). Sedatives and analgesics were used more frequently in the younger group (p < .001). Goal-directed fluid therapy was used more frequently in the older patients (59% vs 52%, p < .004).

These findings support the safety of ERAS implementation in older patients, demonstrating comparable rates of post-operative complications, readmissions, and reoperations across age groups, regardless of comorbidities. Length of stay and overall compliance differed significantly between the age groups.