Our Summary

This study looks at the impact of Enhanced Recovery Programmes (ERPs), which aim to speed up recovery after surgery, on older patients undergoing colorectal surgery. The researchers analyzed 21 studies involving 3495 patients aged 65 or older who were part of ERPs. They found that these programmes generally followed standard guidelines and involved about 13 different steps. The highest adherence rates were found for steps like pre-admission counselling, avoiding bowel preparation, limiting fasting before surgery, and other procedures.

On average, these patients stayed in the hospital for about 6 days after surgery. Around 23.5% experienced some post-surgery complications while in the hospital and 29.8% did within 30 days of the procedure. The death rate within the hospital was 0% in most studies, but around 1.4% within 30 days after surgery. About 4.9% of patients had to be readmitted within 30 days and 5% needed another surgery.

The study concludes that ERPs for older patients are generally following the recommended guidelines. However, they also note that the amount of steps in the programme has increased over time, but the results have stayed the same. They suggest that more research should be done into how well patients stick to the programme and how factors like frailty might impact this.

FAQs

  1. What are Enhanced Recovery Programmes (ERPs) and how do they impact older patients undergoing colorectal surgery?
  2. What is the average hospital stay and complication rate for older patients undergoing colorectal surgery as part of ERPs?
  3. What are the conclusions and recommendations of the study regarding the implementation of ERPs for older patients undergoing colorectal surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about colorectal surgery is to follow the Enhanced Recovery Programme (ERP) guidelines closely to help speed up recovery and reduce complications. This may include steps such as pre-admission counselling, avoiding bowel preparation, limiting fasting before surgery, and following post-operative instructions carefully. It’s also important to communicate any concerns or questions with your healthcare team throughout the process.

Suitable For

Patients who are typically recommended colorectal surgery include those with conditions such as colorectal cancer, inflammatory bowel disease, diverticulitis, colorectal polyps, and other colorectal disorders. Older patients aged 65 and above may also be recommended for colorectal surgery, especially if they are fit for surgery and have a good chance of recovery. Enhanced Recovery Programmes (ERPs) are often recommended for these patients to help speed up their recovery and reduce the risk of complications.

Timeline

Before colorectal surgery:

  • Patients undergo pre-admission counseling
  • Patients avoid bowel preparation
  • Patients limit fasting before surgery
  • Patients follow about 13 different steps in the Enhanced Recovery Programme

After colorectal surgery:

  • Patients stay in the hospital for an average of 6 days
  • 23.5% experience post-surgery complications while in the hospital
  • 29.8% experience post-surgery complications within 30 days
  • Death rate within the hospital is 0% in most studies, but around 1.4% within 30 days
  • 4.9% of patients are readmitted within 30 days
  • 5% of patients need another surgery

Overall, Enhanced Recovery Programmes for older patients undergoing colorectal surgery are generally following recommended guidelines, but more research is needed to understand patient adherence and the impact of factors like frailty.

What to Ask Your Doctor

Some questions a patient should ask their doctor about colorectal surgery include:

  1. What specific steps are included in the Enhanced Recovery Programme for colorectal surgery?
  2. How long can I expect to stay in the hospital after the surgery?
  3. What are the potential post-surgery complications that I should be aware of?
  4. What is the mortality rate for older patients undergoing colorectal surgery within 30 days?
  5. What are the chances of needing to be readmitted or undergoing another surgery within 30 days?
  6. How does frailty impact the success of the Enhanced Recovery Programme for older patients?
  7. Are there any specific guidelines or recommendations I should follow before and after the surgery to optimize my recovery?
  8. What can I do to prepare myself physically and mentally for the surgery?
  9. Are there any lifestyle changes I should consider making after the surgery to improve my long-term outcome?
  10. How can I best communicate any concerns or questions I have throughout the surgical process?

Reference

Authors: Fagard K, Wolthuis A, D’Hoore A, Verhaegen M, Tournoy J, Flamaing J, Deschodt M. Journal: BMC Geriatr. 2019 Jun 6;19(1):157. doi: 10.1186/s12877-019-1158-3. PMID: 31170933