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Erschienen in: European Surgery 4/2019

14.05.2019 | original article

Enhanced recovery after colorectal surgery: the clinical and economic benefit in elderly patients

verfasst von: Petr Kocián, M.D. Ph.D., Adam Whitley, M.D., Petr Přikryl, M.D., Markéta Bocková, M.D., Daniel Hodyc, M.D. Ph.D., Blanka Čermáková, M.Phil., Tomáš Vymazal, M.D. Ph.D., Jiří Hoch, M.D. Ph.D.

Erschienen in: European Surgery | Ausgabe 4/2019

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Summary

Background

We performed this study to investigate the feasibility and clinical and financial benefit of an enhanced recovery after surgery (ERAS) protocol in elderly patients undergoing colorectal resections.

Methods

Patients over the age of 65 undergoing open colorectal resections at the department of surgery of the Motol University Hospital in Prague between January 2015 and August 2017 were included in the study. Patients who received ERAS perioperative care formed the ERAS group and patients who received standard perioperative care formed the control group. Adherence to the ERAS protocol, hospitalisation length, readmission rate, 30-day postoperative morbidity and mortality, and treatment costs were analysed.

Results

Seventy-four patients were included in the ERAS group and sixty-one in the control group. Patient and surgical characteristics were similar in the two groups. An adherence of 83.8% to the ERAS protocol was achieved. Recovery parameters were improved and hospital stay length was shortened, while readmission rate, morbidity and mortality. Although not statistically significant, treatment costs were reduced by an average of €1187 per patient.

Conclusion

We showed that our enhanced recovery after colorectal surgery protocol in elderly patients is feasible, effective, safe and reduces treatment costs.
Literatur
1.
Zurück zum Zitat Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.CrossRefPubMed Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.CrossRefPubMed
2.
Zurück zum Zitat Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: A meta-analysis of randomized controlled trials. World J Surg. 2014;38:1531–41.CrossRefPubMed Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: A meta-analysis of randomized controlled trials. World J Surg. 2014;38:1531–41.CrossRefPubMed
3.
Zurück zum Zitat Lemanu DP, Singh PP, Stowers MD, et al. A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery. Colorectal Dis. 2014;16:338–46.CrossRefPubMed Lemanu DP, Singh PP, Stowers MD, et al. A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery. Colorectal Dis. 2014;16:338–46.CrossRefPubMed
4.
Zurück zum Zitat Nelson G, Kiyang LN, Chuck A, et al. Cost impact analysis of enhanced recovery after surgery program implementation in Alberta colon cancer patients. Curr Oncol. 2016;23:e221–e7.CrossRefPubMedPubMedCentral Nelson G, Kiyang LN, Chuck A, et al. Cost impact analysis of enhanced recovery after surgery program implementation in Alberta colon cancer patients. Curr Oncol. 2016;23:e221–e7.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Thanh NX, Chuck AW, Wasylak T, et al. An economic evaluation of the enhanced recovery after surgery (ERAS) multisite implementation program for colorectal surgery in Alberta. Can J Surg. 2016;59:415–21.CrossRefPubMedPubMedCentral Thanh NX, Chuck AW, Wasylak T, et al. An economic evaluation of the enhanced recovery after surgery (ERAS) multisite implementation program for colorectal surgery in Alberta. Can J Surg. 2016;59:415–21.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Zhuang CL, Ye XZ, Zhang XD, et al. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: A meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667–78.CrossRefPubMed Zhuang CL, Ye XZ, Zhang XD, et al. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: A meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667–78.CrossRefPubMed
7.
Zurück zum Zitat Wang Q, Suo J, Jiang J, et al. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: A randomized trial. Colorectal Dis. 2012;14:1009–13.CrossRefPubMed Wang Q, Suo J, Jiang J, et al. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: A randomized trial. Colorectal Dis. 2012;14:1009–13.CrossRefPubMed
8.
Zurück zum Zitat Lau CS, Chamberlain RS. Enhanced recovery after surgery programs improve patient outcomes and recovery: A meta-analysis. World J Surg. 2017;41:899–913.CrossRefPubMed Lau CS, Chamberlain RS. Enhanced recovery after surgery programs improve patient outcomes and recovery: A meta-analysis. World J Surg. 2017;41:899–913.CrossRefPubMed
10.
Zurück zum Zitat Bagnall NM, Malietzis G, Kennedy RH, et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis. 2014;16:947–56.CrossRefPubMed Bagnall NM, Malietzis G, Kennedy RH, et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis. 2014;16:947–56.CrossRefPubMed
11.
Zurück zum Zitat Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics. CA Cancer J Clin. 2017;2017(67):177–93.CrossRef Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics. CA Cancer J Clin. 2017;2017(67):177–93.CrossRef
12.
Zurück zum Zitat Saxton A, Velanovich V. Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg. 2011;253:1223–9.CrossRefPubMed Saxton A, Velanovich V. Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg. 2011;253:1223–9.CrossRefPubMed
13.
Zurück zum Zitat Sandini M, Pinotti E, Persico I, et al. Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open. 2017;1:128–37.CrossRefPubMedPubMedCentral Sandini M, Pinotti E, Persico I, et al. Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open. 2017;1:128–37.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Venara A, Barbieux J, Mucci S, et al. Short-term outcomes of colorectal resection for cancer in elderly in the era of enhanced recovery. Scand J Surg. 2018;107:31–7.CrossRefPubMed Venara A, Barbieux J, Mucci S, et al. Short-term outcomes of colorectal resection for cancer in elderly in the era of enhanced recovery. Scand J Surg. 2018;107:31–7.CrossRefPubMed
15.
Zurück zum Zitat Gonzalez-Ayora S, Pastor C, Guadalajara H, et al. Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. Int J Colorectal Dis. 2016;31:1625–31.CrossRefPubMedPubMedCentral Gonzalez-Ayora S, Pastor C, Guadalajara H, et al. Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. Int J Colorectal Dis. 2016;31:1625–31.CrossRefPubMedPubMedCentral
Metadaten
Titel
Enhanced recovery after colorectal surgery: the clinical and economic benefit in elderly patients
verfasst von
Petr Kocián, M.D. Ph.D.
Adam Whitley, M.D.
Petr Přikryl, M.D.
Markéta Bocková, M.D.
Daniel Hodyc, M.D. Ph.D.
Blanka Čermáková, M.Phil.
Tomáš Vymazal, M.D. Ph.D.
Jiří Hoch, M.D. Ph.D.
Publikationsdatum
14.05.2019
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2019
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-019-0595-8

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