title: The safety of a "fast-track" program after laparoscopic colorectal surgery is comparable in older patients as in younger patients.
abstract: BACKGROUND
  Fast-track protocols, introduced in the late 1990 s, have been applied in several surgical fields, particularly for colorectal surgery. However, currently many surgical patients are elderly, and discussion about the application of such programs for elderly patients is lacking. The present study was designed to assess the safety of application of a fast-track program after laparoscopic colorectal surgery in elderly patients.
  
  
  METHODS
  From August 2009 to January 2011, we prospectively collected data from patients who underwent laparoscopic colorectal surgery with a perioperative fast-track program. The data of patients older and younger than 70 years were compared.
  
  
  RESULTS
  Of a total of 337 patients, the group of patients older than 70 years (OG) totaled 87 (25.8 %) and the younger group (YG) totaled 250 (74.2 %). Ten patients (11.5 %) were excluded in the OG and 24 (9.6 %) in the YG. There were no differences in gender, history of previous surgeries, body mass index, type of operation, operative time, or blood loss between groups. Age (74.8 vs. 56.7 years, p < 0.001), presence of comorbidities (70.1 vs. 44.7 %, p < 0.001), and ASA score (I:II:III, 33.8:57.1:9.1 vs. 60.6:33.2:6.2 %, p < 0.001) were significantly different between the two groups. Postoperative course did not show differences, including return of flatus, stool passage, advancement of diet, removal of urinary catheter, length of usage of IV antibiotics, complications, and length of postoperative stay. Emergency department visits or readmission within a month after discharge were more frequent in the OG (11.7 %) than the YG (4 %; p = 0.013).
  
  
  CONCLUSIONS
  Fast-track after laparoscopic colorectal surgery can be safely applied in carefully selected elderly patients older than age 70 years. Physicians should keep in mind complications that may present after discharge and should actively educate patients about them.
authors.affiliation: Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul, 136-705, Korea. xezin@korea.ac.kr
authors.forename: Se-Jin
authors.initials: SJ
authors.lastname: Baek
authors.forename: Seon-Hahn
authors.initials: SH
authors.lastname: Kim
authors.forename: Se-Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Shin
authors.forename: Jung-Myun
authors.initials: JM
authors.lastname: Kwak
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors