title: Fast track for elderly patients: is it feasible for colorectal surgery?
abstract: BACKGROUND
  Fast-track program has been applied in several surgical fields. However, currently many surgical patients are elderly over 70 years of age, and discussion about the application of such protocols for elderly patients is inadequate.
  
  
  METHODS
  The present study was designed to consider the safety and feasibility of application of a fast-track program after colorectal surgery in elderly patients. A total of 76 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care program (n = 40) or the conventional perioperative care protocol (control group, n = 36). The fast track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups.
  
  
  RESULTS
  The length of time to regain bowel function, including the passage of flatus [32 (24-40) h vs 42 (32-52) h], and to start a liquid diet (13 [10-16] h v/s 43 [36-50] h) were significantly shorter in patients receiving the fast track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care [6 (5-7) days v/s 9.5 (7-12) days]. A reduced percentage of patients who developed general complications was also observed in the fast-track group (5.0% v/s 18%).
  
  
  CONCLUSIONS
  Fast-track after laparoscopic colorectal surgery can be safely applied in carefully selected elderly patients older than age 70 years. The fast-track recovery program resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol.
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: ritacompagna@libero.it.
authors.forename: Rita
authors.initials: R
authors.lastname: Compagna
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: aprea@unina.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aprea
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: david.derosa@unina.it.
authors.forename: Davide
authors.initials: D
authors.lastname: De Rosa
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: magentile@unina.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gentile
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: gcestaro@unina.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cestaro
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: federer2987@hotmail.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vigliotti
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: tommasobianco85@gmail.com.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bianco
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: guido.massa@libero.it.
authors.forename: Guido
authors.initials: G
authors.lastname: Massa
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: maurizioamato@gmail.com.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Amato
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: smassa@unina.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Massa
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, 80131 Napoli, Italy. Electronic address: bruno.amato@unina.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D002985:Clinical Protocols; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004434:Early Ambulation; D004750:Enteral Nutrition; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery; D013997:Time Factors
keywords: Elderly patients; Fast-track rehabilitation; Laparoscopic colorectal surgery