Age is an independent risk factor for increased morbidity in elective colorectal cancer surgery despite an ERAS protocol
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ORIGINAL ARTICLE
Age is an independent risk factor for increased morbidity in elective colorectal cancer surgery despite an ERAS protocol Dedrick Kok Hong Chan 1,2
&
Jia Jun Ang 1 & Jarrod Kah Hwee Tan 1 & Daryl Kai Ann Chia 1
Received: 8 May 2020 / Accepted: 3 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Elderly patients with colorectal cancer are high-risk surgical candidates. ERAS protocols have been developed to mitigate against these risks. We performed this study to quantify the risks which elderly patients face and then to determine independent risk factors for short-term ERAS-specific outcomes. Methods An analysis of a prospectively collected audit database of all patients who underwent elective colorectal cancer resection within an ERAS framework from January 2018 to December 2018 was performed. Elderly was defined in our study as age ≥ 65 years. Results There were 172 elective colorectal cancer resections performed. Ninety-seven (56.4%) were elderly. Elderly patients were at increased risk of developing post-operative complications (33.0% vs 16.0%, p = 0.011), longer time to diet (3.4 vs 2.2 days, p = 0.001), and longer hospital stay (10.9 vs 6.7 days, p = 0.007). Independent risk factors were determined for the abovementioned three outcomes. Elderly status was the only risk factor for increased complications (OR 2.61 95% CI (1.05– 6.51), p = 0.040). For delayed time to soft diet, male gender (OR 6.67(1.92–20.0), p = 0.002), open approach (OR 9.06(2.26– 36.30), p = 0.002), and increased operative time (OR 1.01(1.00–1.01) p = 0.014) were risk factors. Finally, elderly age (OR 5.53(1.82–16.84), p = 0.003), leucocyte count (OR 1.39(0.76–2.57), p = 0.038), open approach (OR 5.26(1.41–19.62), p = 0.013), operative time (OR 1.01(1.00–1.01), p = 0.021), and Clavien-Dindo classification (OR 7.97(1.27–49.88), p = 0.027) were risk factors for prolonged length of stay. Conclusion Elderly patients are intrinsically at risk for increased complications, longer time to soft diet and longer hospital stay. ERAS protocols may need to be specifically tailored for elderly patients. Keywords Elderly . Geriatric . Colorectal cancer . ERAS . Outcomes
Introduction The incidence of colorectal cancer amongst the elderly is expected to rise, given the rapidly ageing demographic in many countries. With increases in life expectancy and advances in Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01930-y) contains supplementary material, which is available to authorized users. * Dedrick Kok Hong Chan [email protected] 1
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore
2
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
medical care, the number of individuals aged 60 and above will account for 22% of the world’s population by 2050 and number over 2 billion peop
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