title: Enhanced recovery ERAS for elderly: a safe and beneficial pathway in colorectal surgery.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) pathway includes recovery goals requiring active participation of the patients; this may be perceived as "aggressive" care in older patients. The aim of the present study was to assess whether ERAS was feasible and beneficial in older patients.
  
  
  METHODS
  Since June 2011, all consecutive colorectal patients were included in an ERAS pathway and documented in a dedicated prospective database. This retrospective analysis included 513 patients, 311 younger patients (<70 years) and 202 older patients (≥70 years). Outcomes were adherence to the ERAS pathway, functional recovery, postoperative complications, and hospital stay.
  
  
  RESULTS
  Older patients had significantly more diabetes, malignancies, cardiac, and respiratory co-morbidities; both groups underwent similar surgical procedures. Overall adherence to the ERAS pathway was in median 78 % in younger and 74 % in older patients (P = 0.86). In older patients, urinary drains were kept longer (P = 0.001), and oral fluid intake was reduced from day 0 to day 3 (P < 0.001). There were no differences in mobilization and intake of nutritional supplements. Postoperative complications were similar for both comparative groups (51.5 vs. 46.6 %, P = 0.32). Median length of stay was 7 days (IQR 5-13) in older patients vs. 6 days (IQR 4-10) in the younger group (P = 0.001).
  
  
  CONCLUSIONS
  Adherence to the ERAS pathway was equally high in older patients. Despite more co-morbidities, older patients did not experience more complications. Recovery was similar and hospital stay was only 1 day longer than in younger patients. ERAS pathway is of value for all patients and does not need any adaptation for the elderly.
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: J
authors: J
authors: Slieker
authors: Faculty of Medicine, UNIL University, Lausanne, Switzerland.
authors: P
authors: http://orcid.org/0000-0002-1311-2189
authors: P
authors: Frauche
authors: Faculty of Medicine, UNIL University, Lausanne, Switzerland.
authors: J
authors: J
authors: Jurt
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: V
authors: V
authors: Addor
authors: Department of Anesthesiology, University Hospital CHUV, Lausanne, Switzerland.
authors: C
authors: C
authors: Blanc
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland. demartines@chuv.ch.
authors: Nicolas
authors: N
authors: Demartines
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: M
authors: M
authors: Hübner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery; D019091:Critical Pathways; D003710:Demography; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010349:Patient Compliance; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function
keywords: Adherence; Colorectal surgery; Enhanced recovery after surgery; Postoperative complications in elderly