Elderly patients over 70 years benefit from enhanced recovery programme after colorectal surgery as much as younger patients - 02/02/20
Les patients âgés de plus de 70 ans bénéficient autant du programme de récupération après une chirurgie colorectale que les patients plus jeunes
, G. Hans a, C. Coimbra b, E. Decker b, A. Kaba aBienvenue sur EM-consulte, la référence des professionnels de santé.
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| Iconographies | 2 |
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Highlights |
• | Enhanced recovery programme (ERP) after elective colorectal surgery is feasible and efficient in elderly patients. |
• | Elderly patients comply with the ERP satisfactorily and do not require adaptation of protocol, beside the respect of contraindication(s) due to co-morbidities. |
• | Length of hospital stay and incidences of medical as well as surgical complications are similar in young and older patients in spite of more risk factors for postoperative complications in elderly. |
• | Elderly population benefits from this pathway as much as younger patients after elective colorectal surgery and should not be excluded from enhanced recovery programme. |
Summary |
Aim of the study |
Enhanced recovery programme (ERP) reduces length of hospital stay (LOS) and postoperative complications after colorectal surgery. ERP is feasible and effective in elderly patients. We tested the hypothesis of non-inferiority for elderly patients as compared to younger patients with regard to LOS.
Patients and methods |
The first 302 consecutive patients scheduled for colorectal surgery and prospectively introduced in our audit database were retrospectively analysed. LOS (primary endpoint), postoperative complications, and adherence to the ERP of elderly (≥70 years, n=100) were compared with those of younger patients (n=202). The same ERP was used in all patients. Non-inferiority hypothesis for LOS was tested using the confidence interval method. Secondary endpoints were compared using the Mann–Whitney U and the Chi2 tests.
Results |
Except for age patients’ demographic data were not different in both groups: 53.8 (17-69) vs. 76.8 (70-90) years. The actual LOS were 3.5 [2–7] and 4.0 [3–7] days in the young and elderly group, respectively. The difference in median LOS between the two groups was 0 (95% CI, -0.97–0.97), demonstrating non-inferiority. Although with more risk factors (anaemia, COPD, cardiac disease, and cancer, P<0.05), elderly patients experienced neither more postoperative medical (17.0 vs. 16.3 %) nor surgical (19.0 vs. 22.3 %) complications than young patients. The adherence to protocol was slightly less in elderly (16 [15–18] vs. 17 [16–18], P=0.05).
Conclusion |
Not only ERP is feasible in seniors, but elderly patients benefit from this perioperative care as much as younger patients.
Clinical Trials registration |
NCT03620851
Le texte complet de cet article est disponible en PDF.Keywords : Elderly, Enhanced recovery protocol, Patient compliance, Postoperative complications, Surgery: Colorectal
Plan
| ☆ | Presented in part in the 3rd symposium of GRACE (Groupe francophone de Réhabilitation Améliorée après ChirurgiE; Baumont, France: www.grace-asso.fr/) in Paris the 29th of June 2017. |
Vol 157 - N° 1
P. 23-31 - février 2020 Retour au numéro
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