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Effectiveness of enhanced recovery after surgery protocols in elderly patients undergoing major abdominal surgery: a
Kexuan Zhu1, Qingkun Zhou2, Xuhui Xu2
1School of Medicine and Nursing, Nanjing University of Chinese Medicine Hanlin College, Taizhou, Jiangsu, China.
Background:
Enhanced Recovery After Surgery (ERAS) protocols have been widely adopted in perioperative care, but their effectiveness and safety in elderly patients undergoing major abdominal surgery remain subjects of ongoing investigation. To systematically evaluate the effectiveness of ERAS protocols compared with conventional care in elderly patients (≥65 years) undergoing major abdominal surgery.
Methods:
A systematic search was conducted in PubMed, Cochrane Library, Embase, and Web of Science from inception to December 2024. Randomized controlled trials (RCTs) and prospective cohort studies comparing ERAS with conventional care in elderly patients undergoing major abdominal surgery were included. The primary outcome was length of hospital stay (LOS). Secondary outcomes included total complication rate, 30-day mortality, and 30-day readmission rate. ERAS components, protocol compliance, baseline characteristics, and complication definitions were extracted when available. Meta-analyses were performed using random-effects models with subgroup and sensitivity analyses.
Results:
Fifteen studies (6 RCTs and 9 prospective cohort studies) involving 2,397 patients were included. Most studies evaluated colorectal surgery, while two involved hepatectomy and two involved gastrectomy. ERAS pathways consistently included early feeding, early mobilization, and reduced routine tube use, but reporting of protocol details and compliance was variable; overall compliance was reported in 6 of 15 studies (range 42%-89.6%). ERAS significantly reduced LOS compared with conventional care (MD = -3.31 days, 95% CI: -3.74 to -2.88, P < 0.0001). ERAS was associated with a significantly lower complication rate (RR = 0.63, 95% CI: 0.56-0.71, P < 0.0001) and a borderline reduction in 30-day mortality (RR = 0.53, 95% CI: 0.28-1.00, P = 0.049). No significant difference was observed in 30-day readmission rate (RR = 0.78, 95% CI: 0.56-1.08, P = 0.135). Sensitivity analysis excluding the one non-elderly hepatectomy trial yielded materially similar results.
Conclusions:
ERAS protocols appear effective and generally safe in older patients undergoing major abdominal surgery, reducing hospital stay and postoperative complications without increasing readmission rates. However, interpretation should account for variability in ERAS implementation, incomplete compliance reporting, and the combination of randomized and prospective cohort evidence.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261381194, PROSPERO CRD420261381194.
