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Enhanced recovery after surgery (ERAS) program in octogenarian patients: a propensity score matching analysis on the “Lazio Network” database

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Abstract

Purpose

The aim of this study was to evaluate the safety and compliance with the enhanced recovery after surgery (ERAS) protocol in octogenarian patients undergoing colorectal surgery in 12 Italian high-volume centers.

Methods

A retrospective analysis was conducted in a consecutive series of patients who underwent elective colorectal surgery between 2016 and 2018. Patients were grouped by age (≥ 80 years vs < 80 years), propensity score matching (PSM) analysis was performed, and the groups were compared regarding clinical outcomes and the mean number of ERAS items applied.

Results

Out of 1646 patients identified, 310 were octogenarians. PSM identified 2 cohorts of 125 patients for the comparison of postoperative outcomes and ERAS compliance. The 2 groups were homogeneous regarding the clinical variables and mean number of ERAS items applied (11.3 vs 11.9, p-ns); however, the application of intraoperative items was greater in nonelderly patients (p 0.004). The functional recovery was similar between the two groups, as were the rates of postoperative severe complications and 30-day mortality rate. Elderly patients had more overall complications. Furthermore, the mean hospital stay was higher in the elderly group (p 0.027). Multivariable analyses documented that postoperative stay was inversely correlated with the number of ERAS items applied (p < 0.0001), whereas age ≥ 80 years significantly correlated with the overall complication rate (p 0.0419).

Conclusion

The ERAS protocol is safe in octogenarian patients, with similar levels of compliance and surgical outcomes. However, octogenarian patients have a higher rate of overall complications and a longer hospital stay than do younger patients.

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“Lazio Network” Collaborators:

Domenico Spoletini [1], Rosa Marcellinaro [1], Filippo Palla [1], Gian Marco Giorgetti [1], Domenico D’Ugo [2], Liliana Sollazzi [2], Maria Cristina Mele [2], Antonio Gasbarrini [2], Francesco Brunetti [2], Emanuele Rinninnella [2], Marco Cintoni [2], Enrica Adducci [2], Giovanni Battista Levi Sandri [3], Paola Marino [4], Raffaello Mancini [4], Marcello Gasparrini [5], Fabrizio Apponi [5], Fabiana Troisi [5], Gherardo Romeo [5], Giuseppe Pedullà [8], Raffaele Donadio [8], Giulia Russo [7], Lorenzo Firmi [7], Andrea Mazzari [8], Paolo Diamanti [8], Lucilla Muccichini [8], Damiano Menghetti [8], Augusto Belardi [9], Riccardo Angeloni [9], Elena Bonasera [9], Danela Cappelloni [9], Luciana Minieri [9], Andrea Sagnotta [9], Gloria Folliero [9], Luigi Solinas [9], Pietro Maria Amodio [10], Alessandro Arturi [11], Corrado Ferraris [11], Giorgio Capuano [11], Eugenia Puleo [11], Matteo De Stefano [12], Marcello Palladino [12], Francesca Pietrosanti [12]

1-S. Eugenio Hospital, Rome, Italy

2-Fondazione Policlinico Universitario “A. Gemelli” – IRCCS, Rome, Italy

3-Santa Scolastica Hospital, Cassino, Frosinone, Italy

4-San Giovanni-Addolorata Hospital, Rome, Italy

5-Sant’Andrea University Hospital. “La Sapienza” University, Rome, Italy

6-San Paolo Hospital, Civitavecchia, Rome, Italy

7-San Camillo De Lellis Hospital, Rieti, Italy

8-Cristo Re Hospital, Rome, Italy

9-San Filippo Neri Hospital, Rome, Italy

10-Belcolle Hospital, Viterbo, Italy

11-San Pietro Fatebenefratelli Hospital, Rome, Italy

12-Santa Maria Goretti Hospital, Latina, Italy

Author information

Authors and Affiliations

  1. S. Eugenio Hospital, Rome, Italy

    Michele Grieco, Giampaolo Galiffa & Massimo Carlini

  2. Fondazione Policlinico Universitario “A. Gemelli” – IRCCS, Rome, Italy

    Laura Lorenzon, Giuseppe Marincola & Roberto Persiani

  3. Santa Scolastica Hospital, Cassino, Frosinone, Italy

    Roberto Santoro

  4. San Giovanni-Addolorata Hospital, Rome, Italy

    Graziano Pernazza

  5. Sant’Andrea University Hospital. “La Sapienza” University, Rome, Italy

    Antonio Brescia

  6. San Paolo Hospital, Civitavecchia, Rome, Italy

    Emanuele Santoro

  7. San Camillo De Lellis Hospital, Rieti, Italy

    Francesco Stipa

  8. Cristo Re Hospital, Rome, Italy

    Antonio Crucitti

  9. San Filippo Neri Hospital, Rome, Italy

    Stefano Mancini

  10. Belcolle Hospital, Viterbo, Italy

    Raffaele Macarone Palmieri

  11. San Pietro Fatebenefratelli Hospital, Rome, Italy

    Massimiliano Di Paola

  12. Santa Maria Goretti Hospital, Latina, Italy

    Marco Sacchi

Authors
  1. Michele Grieco
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  2. Giampaolo Galiffa
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  3. Laura Lorenzon
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  4. Giuseppe Marincola
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  5. Roberto Persiani
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  6. Roberto Santoro
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  7. Graziano Pernazza
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  8. Antonio Brescia
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  9. Emanuele Santoro
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  10. Francesco Stipa
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  11. Antonio Crucitti
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  12. Stefano Mancini
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  13. Raffaele Macarone Palmieri
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  14. Massimiliano Di Paola
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  15. Marco Sacchi
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  16. Massimo Carlini
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Consortia

on behalf of Lazio Network study group

  • Domenico Spoletini
  • , Rosa Marcellinaro
  • , Filippo Palla
  • , Gian Marco Giorgetti
  • , Domenico D.’Ugo
  • , Liliana Sollazzi
  • , Maria Cristina Mele
  • , Antonio Gasbarrini
  • , Francesco Brunetti
  • , Emanuele Rinninnella
  • , Marco Cintoni
  • , Enrica Adducci
  • , Giovanni Battista Levi Sandri
  • , Paola Marino
  • , Raffaello Mancini
  • , Marcello Gasparrini
  • , Fabrizio Apponi
  • , Fabiana Troisi
  • , Gherardo Romeo
  • , Giuseppe Pedullà
  • , Raffaele Donadio
  • , Giulia Russo
  • , Lorenzo Firmi
  • , Andrea Mazzari
  • , Paolo Diamanti
  • , Lucilla Muccichini
  • , Damiano Menghetti
  • , Augusto Belardi
  • , Riccardo Angeloni
  • , Elena Bonasera
  • , Danela Cappelloni
  • , Luciana Minieri
  • , Andrea Sagnotta
  • , Gloria Folliero
  • , Luigi Solinas
  • , Pietro Maria Amodio
  • , Alessandro Arturi
  • , Corrado Ferraris
  • , Giorgio Capuano
  • , Eugenia Puleo
  • , Matteo De Stefano
  • , Marcello Palladino
  •  & Francesca Pietrosanti

Contributions

Michele Grieco coordinates the work of the “Lazio Network” study group, designed the study, and wrote the manuscript. Giampaolo Galiffa, Laura Lorenzon, and Giuseppe Marincola collaborated on the manuscript writing and produced the statistical analysis. Roberto Persiani, Roberto Santoro, Graziano Pernazza, Antonio Brescia, Emanuele Santoro, Francesco Stipa, Antonio Crucitti, Stefano Mancini, Raffaele Macarone Palmieri, Massimiliano Di Paola, Marco Sacchi, and Massimo Carlini are the directors of the surgical departments involved in the study and collaborated on the activities of the “Lazio Network” study group.

Corresponding author

Correspondence to Michele Grieco.

Ethics declarations

Research involving human participants and/or animals

This research involves only human participants and no animals and was performed in accordance with the 1964 Helsinki declaration. This study was first approved by the institutional Ethics Committee of Fondazione Policlinico Universitario A. Gemelli IRCCS (protocol number 000767418) and then approved by the institutional ethics committee of every participating center.

Informed consent

Informed consent was obtained from all patients.

Conflict of interest

The authors declare no competing interests.

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Grieco, M., Galiffa, G., Lorenzon, L. et al. Enhanced recovery after surgery (ERAS) program in octogenarian patients: a propensity score matching analysis on the “Lazio Network” database. Langenbecks Arch Surg 407, 3079–3088 (2022). https://doi.org/10.1007/s00423-022-02580-y

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  • DOI: https://doi.org/10.1007/s00423-022-02580-y

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