The Role of Enhanced Recovery Programmes in Elderly Patients Undergoing Thoracic Surgery
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PULMONOLOGY AND RESPIRATORY CARE (D BREEN, SECTION EDITOR)
The Role of Enhanced Recovery Programmes in Elderly Patients Undergoing Thoracic Surgery Niamh O’ Halloran 1 & Alan Soo 1 Published online: 5 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review An ageing population and increasing use of imaging techniques have resulted in a greater number of elderly patients being diagnosed with localised, early stage non-small cell lung cancer (NSCLC). Several physiologic factors contribute to the challenge of thoracic surgery in elderly patients: age-related decline in pulmonary function, comorbid disease such as ischaemic heart disease, diabetes and osteoporosis; and advanced COPD in lifelong smokers. This article will discuss the potential advantages of enrolling elderly patients undergoing thoracic surgery on an enhanced recovery after surgery programme and the effect of such programmes on patient outcomes. Recent Findings Several interventions implemented in the pre-, intra- and post-op periods have been shown to reduce morbidity and mortality in elderly patients undergoing pulmonary resection. Summary No single intervention has the capacity to reduce morbidity and mortality in the elderly undergoing pulmonary resection; however, a series of interventions implemented as an ERAS programme has the potential to improved outcomes in this patient population. Keywords Enhanced recovery after surgery programme . Lung cancer . Geriatric
Introduction Lung cancer is the most prevalent cancer worldwide. In 2018, there were an estimated 2.1 million lung cancer diagnoses accounting for 11.6% of the global cancer burden [1]. An ageing general population and increasing use of imaging techniques, along with advancements in imaging technology, have resulted in a greater number of elderly patients being diagnosed with localised, early stage non-small cell lung cancer (NSCLC) [2]. The median age at which lung cancer is diagnosed is 70 years, and as a result of an ageing population, there will be a future increase in the number of elderly patients who will be diagnosed with a pulmonary malignancy [3•]. Early stage non-small cell lung cancer (NSCLC) accounts for 85%
This article is part of the Topical Collection on Pulmonology and Respiratory Care * Alan Soo [email protected] 1
Department of Cardiothoracic Surgery, Saolta Hospital Health Care Group, University Hospital Galway, Galway, Ireland
of all lung cancer diagnoses and is amenable to surgical resection with curative intent [4]. Decision-making in elderly surgical patients is complicated by multiple comorbidities, polypharmacy and poor physical condition. Factors such as age, poor nutritional state and comorbidities are known causes of delayed recovery and increased morbidity following elective surgery [5]. Several physiologic factors contribute to the challenge of thoracic surgery in elderly patients: age-related decline in lung function; comorbid disease such as ischaemic heart disease, diabetes and osteoporosis; and advance
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