Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection

Table 1 Clinic-pathological characteristics and operative data according to age grouping for the 225 patients under study, n (%)

	Age group
	Group A	Group B	Group C	P value
	(n = 112)	(n = 57)	(n = 56)
Age, yrb	57.1 (18-65)	68.9 (65.5-74.2)	80 (75-91.6)
Male sex	62 (55.4)	35 (61.4)	24 (42.9)	NS
BMI, Kg/m2	25 (3.8)	25.6 (3.7)	24.9 (3.2)	NS
ASA classificationb				< 0.001
I	23 (20.5)	2 (3.5)	1 (1.8)
II	84 (75)	41 (71.9)	36 (64.3)
III	5 (4.5)	14 (24.6)	19 (33.9)
Indication for surgeryb				0.007
Colon cancer	46 (41.1)	37 (64.9)	37 (66.1)
Rectal cancer	32 (28.6)	5 (8.8)	8 (14.3)
Benign	34 (29.4)	15 (26.4)	11 (19.7)
Presence of comorbiditiesb				< 0.001
None	48 (42.9)	12 (21.1)	8 (14.3)
1	41 (36.6)	18 (31.6)	15 (26.8)
≥ 2	23 (20.5)	27 (47.4)	33 (58.9)
Previous surgery	49 (43.7)	33 (57.9)	31 (55.4)	NS
R0 resection	75 (96.2)	42 (100)	45 (100)	NS
TNM Stage				NS
Stage ≤ II	53 (67.9)	28 (66.7)	36 (80)
Stage III	23 (29.5)	11 (26.2)	19 (20)
Stage IV	2 (2.6)	3 (7.1)	-
Extent of surgery				NS
Right hemicolectomy	26 (23.2)	19 (33.3)	23 (41.1)
Left hemicolectomy	46 (41)	28 (49.2)	21 (37.5)
Rectal resections1	32 (28.6)	5 (8.8)	8 (14.3)
Abdominoperineal resection	6 (5.4)	1 (1.7)	-
Others	2 (1.8)	4 (7)	4 (7.1)
Stoma formation				NS
Ileostomy	20 (17.9)	2 (3.6)	5 (8.9)
Colostomy	6 (5.4)	1 (1.8)	1 (1.8)
Time of surgery, min	235 (125-360)	216 (145-340)	220 (125-320)	NS
Estimated blood loss, mL	50 (20-400)	40 (10-400)	50 (20-250)	NS
Conversion to open surgery	2 (1.8)	4 (7)	2 (3.6)	NS

¹Includes extended resections to the upper rectum, anterior resection, low anterior resection and intersphincteric resection. Data are expressed as number of patients (%), mean (standard deviation) or median (range).

^bP < 0.01. BMI: Body mass index; ASA: American Society of Anaesthesiologists.

Table 2 Adherence to the enhanced recovery protocol’s items according to age grouping for the 225 patients under study, n (%)

	Age group
	Group A	Group B	Group C	P value
	(n = 112)	(n = 57)	(n = 56)
Laparoscopy (no conversion)	110 (98.2)	53 (93)	53 (94.6)	NS
Carbohydrate rich drinka	48 (42.9)	26 (45.6)	13 (23.2)	0.022
Respiratory training	106 (94.6)	54 (94.7)	55 (98.2)	NS
Prophylactic antiemetics	109 (97.3)	52 (91.2)	52 (92.9)	NS
Intra-operative warming	108 (96.4)	52 (91.2)	55 (98.2)	NS
No nasogastric tube	101 (90.2)	53 (93)	48 (85.7)	NS
TAP block	62 (55.4)	29 (50.9)	37 (66.1)	NS
Oral liquids POD0	31 (27.7)	14 (24.6)	9 (16.1)	NS
Solid food POD1	46 (41.1)	18 (31.6)	16 (28.6)	NS
Early mobilization	101 (90.2)	51 (89.5)	50 (89.3)	NS
Walking POD1a	57 (50.9)	23 (40.4)	21 (37.5)	0.032
Early UC removala	66 (58.9)	40 (70.2)	24 (42.9)	0.013
Stop iv fluids POD2a	67 (59.8)	36 (63.2)	23 (41.1)	0.032
Opiates avoidancea	56 (50)	22 (38.6)	38 (67.9)	0.007
GC, %	70.3 (36-100)	64.3 (21-100)	64.3 (36-100)	NS
GC < 50%	20 (17.9)	10 (17.5)	13 (23.2)
GC 50%-75%	51 (45.5)	23 (40.4)	29 (51.8)
GC > 75%	41 (36.6)	24 (42.1)	14 (25)

^aP < 0.05. TAP: Transversus abdominis plane; POD: Post-operative day; UC: Urinary catheter; GC: Global compliance.

Table 3 Post-operative complications according to age grouping for the 225 patients under study, n (%)

	Age group
	Group A	Group B	Group C	P value
	(n = 112)	(n = 57)	(n = 56)
Overall complications	29 (25.9)	21 (36.8)	24 (42.9)	NS
Major complications				NS
(Clavien-Dindo ≥ III)	5 (4.5)	2 (3.5)	1 (1.8)
General complicationsa	9 (8.1)	13 (22.8)	11 (19.6)	0.045
Cardiovascular	2 (1.8)	3 (5.3)	7 (12.4)
Respiratory	3 (2.7)	3 (5.3)	2 (3.6)
Urinary tract	1 (0.9)	4 (7)	2 (3.6)
Anemia	1 (0.9)	1 (1.8)	-
Others	2 (1.8)	2 (3.5)	-
Surgical complications	22 (19.6)	11 (19.3)	13 (23.2)	NS
Anastomotic leak	3 (2.7)	1 (1.8)	1 (1.8)
Bowel obstruction	1 (0.9)	2 (3.5)	-
Prolonged post-operative ileus	7 (6.3)	7 (12.2)	6 (10.7)
Bleeding	2 (1.8)	1 (1.8)	1 (1.8)
Gastrointestinal bleeding	1 (0.9)	-	-
Surgical site infection	2 (1.8)	-	4 (7.1)
Others	6 (5.4)	-	1 (1.8)
Infective complications	6 (5.4)	4 (7)	7 (12.5)	NS
RBC transfusion	6 (5.4)	2 (3.5)	5 (9)	NS
Redo Surgery	4 (3.6)	2 (3.5)	1 (1.8)	NS
Anastomotic leak	3 (3.6)	-	1 (1.8)
Internal hernia	1 (.9)	2 (3.5)	-
30-d readmission	3 (3.6)	-	1 (1.8)	NS
30-d mortality	-	-	-

^aP < 0.05. Data are expressed as number of patients (%). RBC: Red blood cells.

Table 4 Meeting criteria for discharge according to age grouping

	Age group
	Group A	Group B	Group C	P value
	(n = 112)	(n = 57)	(n = 56)
Fluid intakea	1 (0-5)	1 (0-7)	1 (0-7)	0.039
Soft diet	2 (1-6)	2 (1-13)	2 (1-9)	NS
Early mobilization	1 (0-3)	1 (0-7)	1 (0-4)	NS
Walking	1 (0-4)	2 (1-8)	2 (1-8)	NS
Bowel open to gas	1 (0-6)	1 (0-4)	1 (0-4)	NS
Bowel open to stoolsa	2 (0-8)	3 (1-9)	3 (1-9)	0.002
Pain control with oral analgesics	3 (2-4)	3 (1-5)	3 (1-4)	NS
Length of stay	5 (2-40)	5 (3-26)	6 (3-22)	NS
Ready for discharge on POD 3, n (%)	72 (64.3)	35 (61.4)	27 (48.2)	NS
Time to readiness for dischargea	3 (3-35)	3 (3-22)	4 (3-18)	0.040
Discharge delay	1 (0-8)	2 (0-8)	2 (0-4)	NS

^aP < 0.05. Data are expressed as number of patients (%) or median (range). POD: Post-operative day.