Enhanced recovery after surgery: adherence and outcomes in elderly patients undergoing VATS lobectomy

Objectives To evaluate whether ERAS is feasible and beneficial in elderly patients undergoing VATS lobectomy for lung cancer. Methods From February 2016 to March 2019, 182 patients were included into a 17-items ERAS pathway. Patients were divided into two groups according to age: Group A (< 75 years) 138 patients and Group B (>= 75 years) 44 patients. End points were: length of stay (LoS), 30-day morbidity, 90-day mortality, 30-day re-admittance rate, and ERAS-score (number of ERAS objectives achieved). Results Elderly patients had significantly more chronic renal failure (p = 0.039) and a worse pulmonary function. Mean FEV1% was 101.6% (+/- 21.0% SD) and 90.8% (+/- 19.1% SD) and mean FEV1/FVC was 0.75 (+/- 0.10 SD) and 0.68 (+/- 0.12 SD) for group A and B, respectively (p = 0.02 andp = 0.01). Median LoS was longer in Group B (6 days) than in Group A (5 days;p = 0.006). Morbidity was higher for elderly patients (A 32.6%vsB 56.8%;p = 0.007), major complication rates were similar (p = 0.782). No post-operative mortality was observed, re-admittance rates were similar (A 7.8% vs B 11.5%;p = 0.548). Mean ERAS-scores were 13.8 (+/- 1.83 SD) for Group A and 13.4 (+/- 1.98 SD) for Group B (p = 0.240). Multivariable analysis showed previous major surgery (p = 0.028), COPD (p = 0.027), history of arrhythmic disease (p = 0.015), post-operative complications (p < 0.001), and ERAS-score (p < 0.001) as independent predictive factors of LoS, age did not significantly influence LoS. Conclusions Elderly patients adhere to an ERAS protocol similarly to younger ones. ERAS pathway in VATS lobectomy patients seems to be beneficial regardless the age.