title: Are enhanced recovery programs in colorectal surgery feasible and useful in the elderly? A systematic review of the literature.
abstract: BACKGROUND
  Enhanced recovery programs (ERP) are no longer questionable in the management of patients undergoing surgery. However, there is some doubt as to their feasibility and efficacy in the elderly. Our goal was to systematically review the evidence-based literature concerning the feasibility of ERP in elderly patients undergoing colorectal surgery.
  
  
  METHODS
  The PubMed and Cochrane Database for systematic reviews as well as the "grey" literature between 2000 and 2015 were sought. Articles were selected if they compared ERP in elderly patients to ERP in young patients (feasibility) or compared ERP to traditional post-operative management in the elderly (efficacy).
  
  
  RESULTS
  Sixteen articles were identified according to the inclusion criteria. All showed that an ERP was feasible in the elderly although post-operative morbidity was higher compared to younger patients. Compared to traditional management, ERP was effective since it decreased (as in the young) the overall rate of complications and thus the duration of hospital stay. There were not enough data on the degree of implementation of ERP and the medico-economic aspects to come to any formal conclusions.
  
  
  CONCLUSIONS
  This comprehensive systematic review of the literature showed that ERP was feasible and effective in the elderly undergoing colorectal surgery. Protocols should be adapted to the particular aspects of this population. Future research should target pre-operative evaluation and the place of pre-habilitation in geriatric ERP.
authors.affiliation: Service de Chirurgie, Centre Hospitalier d'Aracachon, France.
authors.forename: M-V
authors.initials: MV
authors.lastname: Launay-Savary
authors.affiliation: Service de Chirurgie Digestive, Centre Hospitalo-Universitaire Limoges, France.
authors.forename: M
authors.initials: M
authors.lastname: Mathonnet
authors.affiliation: Service d'Anesthésie-Réanimation, centre Hospitalier Princesse Grace, Monaco.
authors.forename: A
authors.initials: A
authors.lastname: Theissen
authors.affiliation: Service de Chirurgie Digestive, Clinique de la Colline Hirslanden, Genève, Suisse.
authors.forename: S
authors.initials: S
authors.lastname: Ostermann
authors.affiliation: Service de Gériatrie, Centre Hospitalo-Universitaire de Bichat, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Raynaud-Simon
authors.affiliation: Service de Chirurgie Digestive, Centre Hospitalo-Universitaire Estaing, Clermont-Ferrand, France. Electronic address: kslim@chu-clermontferrand.fr.
authors.forename: K
authors.initials: K
authors.lastname: Slim
authors.affiliation: 9 allée du Riboulet, Beaumont, France.
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D006801:Humans; D007902:Length of Stay; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Colorectal surgery; Elderly patient; Enhanced recovery after surgery; Morbidity