Before-and-After Study of the First Four Years of the Enhanced Recovery after Surgery (ERAS?) Programme in Older Adults Undergoing Elective Colorectal Cancer Surgery

Background: The aim of this study was to determine whether the inclusion of older patients undergoing elective colorectal cancer resection in the Enhanced Recovery After Surgery (ERAS (R)) programme could improve clinical outcomes during hospital admission. Methods: A before-and-after study in >= 70-year-old patients electively admitted for colorectal cancer resection was designed. In total, 213 patients were included in the ERAS (R) group, and 158 were included in the control group. Results: The average age was 77.9 years old (SD 5.31) and 57.14% of them were men, with a Charlson Index score of 3.42 (SD 3.32). The ERAS (R) group presented a lower transfusion rate of 42 (19.7%), compared to 75 (47.5%) in the control group (p < 0.001). The crude odds ratio (OR) for transfusion was 0.27 (95% CI 0.17-0.43; p < 0.001), and the adjusted odds ratio was 0.26 (95% CI 0.14-0.48; p < 0.001). The ERAS (R) group had a lower percentage of patients with moderate-severe malnutrition on admission, at 23.4% (37 patients) against 36.2% in the control group (42 patients) (p = 0.023), with an OR of 0.47 (95% CI 0.29-0.75; p < 0.002) and an adjusted OR of 0.48 (95% CI 0.29-0.78; p = 0.003). The number of patients who required admission to the intensive care unit (ICU) was also markedly lower: 54 from the ERAS (R) group (25.4%) versus 71 from the control group (44.9%) (p < 0.001). Conclusions: The inclusion of >= 70-year-old adults in the ERAS (R) programme resulted in a decrease in transfusions, number of erythrocyte concentrates transfused, and number of ICU admissions, along with improved nutritional status.