Suitability of enhanced recovery after surgery (ERAS) protocols for elderly colorectal cancer patients

Objective: Enhanced recovery after surgery (ERAS) provides a multimodal approach to postsurgical recovery, seekingto reduce a patient's stress response and promoting recovery. This study aimed to determine the suitability of ERAS protocols for elderly patients above 75 years of age. Methods: This is a retrospective analysis of all patients who had undergone major colorectal resections under ERAS protocols in Khoo Teck Puat Hospital, Singapore and Faculty of Medicine Siriraj Hospital, Thailand between 2013 and 2014. Data collected included patient characteristics and outcomes, including length of hospitalization, and time to first flatus and mobilization. Results: Of the 196 patients studied, 38 were above 75 years of age. Elderly patients were more likely to have more comorbidities, a higher ASA score and a higher POSSUM predicted mortality. They also had an increased risk of developing Clavien 2 complications (OR 2.41, 95% CI 1.10-5.29). Compared to their younger counterparts, elderly patients did not have a delay in first flatus or mobilization. However, they tended to stay longer (7.89 vs. 5.16 days, p<0.001). On multivariate analysis, ASA score of 3 and above was an independent risk factor for a length of stay over 1 week while age was not. Conclusion: This study has shown that elderly patients achieve comparable functional recovery under an enhanced recovery approach. Enhanced recovery after surgery can be adopted regardless of a patient's age.