Enhanced recovery program versus conventional care after colorectal surgery in the geriatric population: a systematic review and meta-analysis.

Introduction: Enhanced recovery after surgery (ERAS) programs for patients undergoing colorectal surgery has yielded promising results. However, there remains controversy regarding the application of ERAS protocols in an elderly population. The aim of this review is to compare the clinical outcomes between ERAS versus conventional peri-operative care (Non-ERAS) for colorectal surgery in patients aged ≥ 65 years old.

Methods: The PRISMA guidelines were adhered to. A comprehensive search was performed using Medline, Embase and the Cochrane Library electronic databases and relevant articles were identified. Indications for the colorectal resections included both benign and malignant diseases, while emergency surgeries were excluded. Primary outcomes include post-operative morbidity, length of stay and re-admission rates. Data analysis was performed using Revman 5.3.

Results: A total of six studies were included, which involved a total of 1174 patients. ERAS was associated with a lower incidence of post-operative morbidity compared to Non-ERAS (OR 0.38, 95% CI 0.25-0.59), p < 0.001). Similarly, ERAS was also associated with a significantly shorter hospital length of stay (MD - 2.49, 95% CI - 4.11 to 0.88, p = 0.002). Return of bowel function as measured by time to flatus was significantly faster in the ERAS group (MD - 20.01 95% CI - 36.23 to 3.79, p = 0.02), but post-operative ileus rates (OR 0.86, 95% CI 0.50-1.47, p = 0.58) were comparable. Re-admission, re-operation and post-operative mortality rates were also similar between both groups.

Conclusion: The application of ERAS protocols in an elderly population provides the advantages of lower post-operative morbidity and shorter hospital length of stay. Future studies should aim to evaluate factors that can improve ERAS compliance rates in this group of patients.