title: A systematic review of enhanced recovery care after colorectal surgery in elderly patients.
abstract: OBJECTIVE
  Enhanced recovery after surgery (ERAS) can decrease complications and reduces hospital stay. Less certain is whether elderly patients can fully adhere to and benefit from ERAS. We aimed to determine the safety, feasibility and efficacy of enhanced recovery after colorectal surgery in patients aged ≥ 65 years old.
  
  
  METHODS
  A systematic search of Medline, EMBASE and Cochrane was performed to identify (i) studies comparing elderly patients managed with ERAS vs traditional care, (ii) cohort studies of ERAS with results of elderly vs younger patients and (iii) any case series of ERAS in elderly patients. End-points of interest were length of hospital stay, complications, mortality, readmission and re-operation, and ERAS protocol adherence.
  
  
  RESULTS
  Sixteen studies were included. Two randomized controlled trials demonstrated shorter hospital stay in elderly patients with ERAS compared with elderly patients with non-ERAS (9 vs 13.2 days, P < 0.001; 5.5 vs 7 days, P < 0.0001). Fewer complications occurred with ERAS in both randomized controlled trials (27.4% vs 58.6%, P < 0.0001; 5% vs 21.1%, P = 0.045). The majority of observational studies did not show differences in outcome between elderly and younger patients in terms of hospital stay, morbidity or mortality. Inconsistent findings between cohort studies may reflect the disparities in ERAS protocol definitions or differences in study populations.
  
  
  CONCLUSIONS
  ERAS can be safely applied to elderly patients to reduce complications and shorten length of hospital stay. Further studies are required to assess whether elderly patients are able to adhere to, and benefit from, ERAS protocols to the same extent as younger patients.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Paddington, London, UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Bagnall
authors.forename: G
authors.initials: G
authors.lastname: Malietzis
authors.forename: R H
authors.initials: RH
authors.lastname: Kennedy
authors.forename: T
authors.initials: T
authors.lastname: Athanasiou
authors.forename: O
authors.initials: O
authors.lastname: Faiz
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000367:Age Factors; D000368:Aged; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D010359:Patient Readmission; D011182:Postoperative Care / Q000379:methods*; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D013997:Time Factors
keywords: Enhanced recovery; colorectal; elderly