title: Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery.
abstract: BACKGROUND
  Elderly patients often are regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The goal of this study was to compare the cost of care and short-term outcomes of elderly and nonelderly patients undergoing laparoscopic colectomy. Our hypothesis was that elderly patients managed with laparoscopic colorectal surgery and an enhanced recovery protocol (ERP) can realize the same benefits of lower hospital length of stay (LOS) without increasing hospital costs or readmission rates.
  
  
  METHODS
  Review of a prospective database identified all patients that underwent an elective laparoscopic colectomy from 2009 to 2012. Patients were stratified into elderly (≥70 years old) and nonelderly (<70 years old) cohorts. The main outcome measures were discharge disposition, hospital costs, hospital LOS, and 30-day readmission rates between the laparoscopic and open groups.
  
  
  RESULTS
  A total of 302 nonelderly (66%) and 153 elderly (34%) patients were included in the analysis. The elderly cohort had significantly higher comorbidities than the nonelderly group. There were no mortalities. Operative variables (procedure time, blood loss, and intraoperative complications) were similar. At discharge, significantly more elderly patients required temporary nursing or home care. There were no significant differences in short-term outcomes of LOS, 30-day readmission rates, or costs for the episode of care between the two groups.
  
  
  CONCLUSIONS
  Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients. Despite higher comorbidities, elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106-5047, USA, debby_keller@hotmail.com.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.forename: Justin K
authors.initials: JK
authors.lastname: Lawrence
authors.forename: Tamar
authors.initials: T
authors.lastname: Nobel
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000368:Aged; D003082:Colectomy / Q000191:economics* / Q000379:methods; D003108:Colonic Diseases / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010351:Patient Discharge / Q000191:economics; D010359:Patient Readmission / Q000191:economics; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome