Feasibility and safety of enhanced recovery after surgery in elderly patients with gastric cancer

Table 1 Enhanced recovery after surgery bundle implementation metrics

Variables	Young group (n = 79; not completed)	Elderly group (n = 82; not completed)
Preoperative measures
Patient education on ERAS	0	0
Nutritional assessment	0	0
Cardiopulmonary exercise training	2	1
Avoidance of routine mechanical bowel preparation	0	1
Reduced preoperative fasting duration	0	0
Take carbohydrates orally	3	5
Standard surgical antibiotic prophylaxis	0	0
Intraoperative measures
Minimal access surgery	1	2
Temperature management	0	0
Intraoperative antibiotic redosing as indicated	0	0
Avoidance of routine nasogastric tube placement	5	3
Selective surgical drainage	0	0
Goal-directed fluid therapy	0	0
Postoperative interventions
Multimodal analgesia	3	2
Lactulose administration	0	3
Clear liquid diet initiation on POD1	9	7
Early removal of urinary catheters and surgical drains	6	11
Early ambulation on POD1	7	9

ERAS: Enhanced recovery after surgery; POD: Postoperative day.

Table 2 Main clinicopathological features of patients in two groups

Variables	Young group (n = 79)	Elderly group (n = 82)	t/Z/χ2	P value
Age (year)	54.3 ± 7.7	71.6 ± 5.0	-16.861	< 0.001
Sex (female/male)	28/52	23/59	1.016	0.313
BMI (kg/m2)			-1	0.117
< 18.5	1 (1.3)	6 (7.3)
≥ 18.5	78 (98.7)	76 (92.7)
ASA I/II/III	37 (46.8)/38 (48.1)/4 (5.1)	13 (15.9)/61 (74.4)/8 (9.8)	18.147	< 0.001
Preoperational albumin (g/L)			0.173	0.677
< 30	8 (10.1)	10 (89.9)
≥ 30	71 (12.2)	72 (87.8)
Preoperative comorbidities
Hypertension	27 (34.2)	48 (58.5)	9.595	0.002
Diabetes	14 (17.7)	31 (37.8)	8.059	0.005
Heart disease	4 (5.1)	14 (17.1)	5.844	0.016
Respiratory diseases	2 (2.5)	9 (11.0)	4.507	0.034
Preoperative WBC (109/L)	5.2 ± 2.0	5.5 ± 2.2	-0.928	0.355
Preoperative CRP (mg/L)	0.5 (0.01)	0.5 (1.9)	-2.686	0.007
Preoperative IL-6 (pg/mL)	3 (5.6)	3.7 (8.1)	-0.842	0.400
TNM classification I/II/III/IV	37 (46.8)/22 (27.8)/17 (21.5)/3 (3.8)	27 (32.9)/30 (36.6)/23 (28.0)/2 (2.4)	3.875	0.267
Number of lymph nodes metastatic	0 (2)	1 (4)	-0.892	0.372
Differentiation			1.806	0.404
Poorly differentiated	27 (34.2)	21 (25.6)
Moderately differentiated	50 (63.3)	57 (69.5)
Highly differentiated	2 (2.5)	4 (4.9)

¹When performing χ² tests, Fisher's exact test did not provide a χ² value in the results.

Data are shown as mean ± SD, median (interquartile range), or n (%). BMI: Body mass index; ASA: American Society of Anesthesiologists classification; WBC: White blood cell; CRP: C-reactive protein.

Table 3 Surgical operations in two groups

Variables	Young group (n = 79)	Elderly group (n = 82)	t/Z/χ2	P value
Operative method			4.423	0.110
Proximal gastrectomy	10 (12.7)	21 (25.6)
Distal gastrectomy	39 (49.4)	36 (43.9)
Total gastrectomy	30 (38.0)	25 (30.5)
Surgical approach			0.037	0.848
Laparoscopy	32 (40.5)	32 (39.0)
Robot assisted surgery	47 (59.5)	50 (61.0)
Conversion to open surgery (yes/no)	1 (1.3)/78 (98.7)	2 (2.4)/80 (97.6)	-1	1.000
Operation time (min)	280.7 ± 54.1	276.4 ± 52.3	0.518	0.605
Intraoperative bleeding volume (mL)	50 (10)	50 (10)	-0.882	0.378
Number of lymph nodes dissection	29.9 ± 12.0	27.3 ± 9.0	1.557	0.121

¹When performing χ² tests, Fisher's exact test did not provide a χ² value in the results.

Data are shown as mean ± SD, median (interquartile range), or n (%).

Table 4 Short-term outcomes after surgery in two groups

Variables	Young group (n = 79)	Elderly group (n = 82)	t/Z/χ2	P value
ERAS compliance rate	68 (86.1)	70 (85.4)	0.017	0.898
Reoperation	1 (1.3)	1 (1.2)	-1	1.000
Preoperative mortality rate within 30 days	0 (0)	0 (0)	-2	-2
Preoperative D1 WBC (109/L)	12.8 ± 3.4	12.1 ± 4.3	1.075	0.284
Preoperative D3 WBC (109/L)	7.9 ± 2.4	8.1 ± 2.7	-0.577	0.565
Preoperative D1 CRP (mg/L)	29.0 (41.6)	30.4 (27.9)	-0.719	0.472
Preoperative D3 CRP (mg/L)	38.3 (52.1)	42.0 (49.2)	-0.955	0.339
Preoperative D1 IL-6 (pg/mL)	23.2 (35.6)	25.4 (47.5)	-0.692	0.489
Preoperative D3 IL-6 (pg/mL)	12.5 (21.7)	13.7 (19.1)	-0.626	0.532
Preoperative first ventilation time (hour)	50.9 ± 18.4	53.4 ± 16.9	-0.877	0.382
Preoperative hospital stays (day)	7 (3)	7 (3)	-1.262	0.207
Preoperative anastomotic leakage	4 (5.1)	3 (3.7)	-1	0.716
Preoperative incision infection	3 (3.8)	4 (4.9)	-1	1.000
Preoperative pulmonary infection	4 (5.1)	5 (6.1)	-1	1.000

¹When performing χ2 tests, Fisher's exact test did not provide a χ² value in the results.

²As the data for "30-day postoperative mortality" showed zero variance, the χ² test did not generate any statistical values (χ² value and P value).

Data are shown as mean ± SD, median (interquartile range), or n (%). Some patients had more than one complication. Patients included in this study were followed up to 30 days after surgery. ERAS: Enhanced recovery after surgery; WBC: White blood cell; CRP: C-reactive protein.