Enhanced Recovery after Surgery (ERAS) Helps Elderly Maintain Their Activities of Daily Living and Improve Quality of Life Following Major Colorectal Surgery–with Comparable Surgical Outcomes to Younger Patients
Varut Lohsiriwat MD, PhD*
Affiliation : * Colorectal Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : This study aimed to evaluate surgical and functional outcomes following the application of enhanced recovery after
surgery (ERAS) in elderly undergoing colorectal resection.
Material and Method: A prospectively collected database of elderly patients (age >75 years) undergoing elective colorectal
surgery under ERAS pathway in Siriraj Hospital from 2011 to 2015 was reviewed. Surgical outcomes of such patients were
compared to those of younger patients. Patient-reported outcome measures were compared between their pre-operative
status and postoperative status by activities of daily living (ADL) using modified Barthal index (MBI: 0 = totally independent
to 100 = totally dependent) and health-related quality of life (HR-QoL) using 100-mm visual analog scale.
Results : This study included 30 elderly patients with median age of 78 years, Charlson Comorbidity Index of 7 and CR-
POSSUM predicted mortality of 3.5%. Compared to younger patients, the elderly had a non-significant higher rate of
complications (31% vs. 15%; p = 0.06) and longer postoperative stay (5 days vs. 4 days; p = 0.12) but comparable time to
tolerate solid diet and time to first defecation. Average ADL-MBI was following: 99 at baseline vs. 96 (p = 0.045), 97 (p =
0.023), 97 (p = 0.07) and 98 (p = 0.07) at 1, 3, 6, and 12 months after surgery, respectively. HR-QoL showed a recovery to
an extent equal to or better than their pre-operative scores: 56 at baseline vs. 55 (p = 0.78), 59 (p = 0.75), 64 (p<0.001) and
72 (p<0.001) at 1, 3, 6, and 12 months after surgery, respectively.
Conclusion : Although the elderly are inherently susceptible to significant comorbidities and high predicted mortality, the
application of ERAS in such patients achieved the same time to gastrointestinal recovery as compared to younger patients.
Additionally, the elderly could maintain their ADL and exhibit better HR-QoL after surgery.
Keywords : Enhanced recovery after surgery, Colon, Rectum, Elderly, Surgery, Function, Activities of daily living, Barthal index, Quality of life
