Deborah S Keller, MD, Justin K Lawrence, MD, Glenn Hall, MD, Tamar Nobel, BS, Conor P Delaney, MD, MCh, PhD
University Hospitals-Case Medical Center
Purpose: Elderly patients are often regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. This study evaluates whether elderly patients managed with laparoscopic colorectal (LC) surgery and an enhanced recovery protocol (ERP) can attain the reduced hospital stay and resource utilization of younger patients.
Methods: Elective LC patients between 2008 and 2012 were identified from a prospective departmental database. Patients were stratified into elderly (≥70 years old) and non-elderly (<70 years old) cohorts; all followed a standardized ERP and discharge criteria. The main outcome measures were hospital costs, hospital length of stay, discharge disposition, and 30-day readmission rates. Statistical analysis was performed with Student’s t-test or Fisher’s exact test, where appropriate.
Results: 455 patients met inclusion criteria for the analysis, of whom 153 were elderly (34%). The elderly cohort had a significantly higher ASA class (2.58 ± 0.53 vs. 2.24 ± 0.54, p = < 0.0001), Charlson Co-morbidity Index (0.71 ± 0.96 vs. 0.41 ± 0.95, p = .0015), and lower BMI (26.91 ± 5.46 vs. 28.50 ± 6.20, p = .0067) than the non-elderly group. Both groups had similar procedure time (p = 0.2377), blood loss (p = 0.2307), and intra-operative complications (p = 1.000). Significantly more elderly patients required home care services (12.4% v. 6.6%, p= 0.0313) or temporary nursing facility care (5.2% vs. <1%, p = 0.0033). There were no significant differences in length of stay (4.91 vs. 4.47 days, p= 0.4565), 30-day readmission rates (5% vs. 6%, p = 0.8248), or costs for the episode of care (p = 0.5479) between groups.
Conclusions: Our results show that combining LC with an ERP is cost-effective and results in similar short-term outcomes for elderly and non-elderly patients. Despite higher co-morbidities, elderly patients realized the same benefits of shorter hospital stay with similar hospital costs and readmission rates.
Program Number: P017