Minimizing the impact of colorectal surgery in the older patient: The role of enhanced recovery programs in older patients

Enhanced recovery after surgery (ERAS) programs are multimodal treatment bundles designed with the aim to decrease the perioperative stress response to surgical trauma and reduce complication rates with elective surgery. They include different items in the preoperative, intra-operative, and postoperative phases that are based on prospective randomized trials with different grades of evidence. Their use is widespread in colorectal surgery and they have been proven to improve outcomes. Older patients are a specific group of patients with particular needs, due to age-related decline in physiological reserve and functional capacity, and frequent co-morbidity. There has been some hesitation to apply ERAS pathways in the older population, because of a lower compliance with the ERAS measures and a higher postoperative morbidity in these patients. However, recent studies have shown that most elements of the ERAS programs can be applied safely in older patients with the same benefits in reducing general complications and perioperative mortality as in younger patients.