TY - JOUR
T1 - EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults
AU - Keller, Deborah S
AU - Curtis, Nathan
AU - Burt, Holly Ann
AU - Ammirati, Carlo Alberto
AU - Collings, Amelia T
AU - Polk, Hiram C
AU - Carrano, Francesco Maria
AU - Antoniou, Stavros A
AU - Hanna, Nader
AU - Piotet, Laure-Meline
AU - Hill, Sarah
AU - Cuijpers, Anne C M
AU - Tejedor, Patricia
AU - Milone, Marco
AU - Andriopoulou, Eleni
AU - Kontovounisios, Christos
AU - Leeds, Ira L
AU - Awad, Ziad T
AU - Barber, Meghan Wandtke
AU - Al-Mansour, Mazen
AU - Nassif, George
AU - West, Malcolm A
AU - Pryor, Aurora D
AU - Carli, Franco
AU - Demartines, Nicholas
AU - Bouvy, Nicole D
AU - Passera, Roberto
AU - Arezzo, Alberto
AU - Francis, Nader
PY - 2024/8
Y1 - 2024/8
N2 - BACKGROUND: As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery. METHODS: Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology. RESULT: Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery. CONCLUSIONS: MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.
AB - BACKGROUND: As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery. METHODS: Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology. RESULT: Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery. CONCLUSIONS: MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.
KW - Abdominal Surgery
KW - Elderly
KW - Enhanced recovery after surgery (ERAS)
KW - Frail
KW - Frailty
KW - Laparoscopy
KW - Older adults/aged
KW - Perioperative care
KW - Prehabilitation
KW - Robotic surgical procedures
U2 - 10.1007/s00464-024-10977-7
DO - 10.1007/s00464-024-10977-7
M3 - Article
SN - 0930-2794
VL - 38
SP - 4104
EP - 4126
JO - Surgical endoscopy and other interventional techniques
JF - Surgical endoscopy and other interventional techniques
IS - 8
ER -