EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults

Deborah S Keller¹, Nathan Curtis², Holly Ann Burt³, Carlo Alberto Ammirati⁴, Amelia T Collings⁵, Hiram C Polk Jr⁵, Francesco Maria Carrano⁶, Stavros A Antoniou⁷, Nader Hanna⁸, Laure-Meline Piotet⁹, Sarah Hill¹⁰, Anne C M Cuijpers¹¹, Patricia Tejedor¹², Marco Milone¹³, Eleni Andriopoulou¹⁴, Christos Kontovounisios¹⁵, Ira L Leeds¹⁶, Ziad T Awad¹⁷, Meghan Wandtke Barber¹⁰, Mazen Al-Mansour¹⁸, George Nassif¹⁹, Malcolm A West^{20

21

22}, Aurora D Pryor²³, Franco Carli²⁴, Nicholas Demartines⁹, Nicole D Bouvy²⁵, Roberto Passera²⁶, Alberto Arezzo⁴, Nader Francis^{27

28}

Affiliations

¹ Department of Digestive Surgery, University of Strasbourg, Strasbourg, FR, USA.
² Surgical Unit, Dorset County Hospital, Dorchester, Dorset, UK.
³ SAGES, Los Angeles, CA, USA.
⁴ Department of Surgical Sciences, University of Torino, Turin, Italy.
⁵ Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
⁶ Department of General and Minimally Invasive Surgery, Busto Arsizio Circolo Hospital, ASST-Valle Olona, Varese, Italy.
⁷ Department of General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece.
⁸ Department of Surgery, Queen's University, Kingston, ON, Canada.
⁹ Department of Surgery, University Hospital CHUV, Lausanne, Switzerland.
¹⁰ Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
¹¹ Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
¹² Department of Colorectal Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
¹³ Department of Clinical and Surgical Gastrointestinal Diseases, University of Naples "Federico II", Via Pansini 5, Naples, Italy.
¹⁴ Department of Surgery, Hellenic Red Cross Korgialeneio Benakeio NHS, Athens, Greece.
¹⁵ Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Campus and the Royal Marsden Hospital, London, UK.
¹⁶ Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
¹⁷ Department of Surgery, University of Florida, Jacksonville, FL, USA.
¹⁸ Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA.
¹⁹ Department of Colorectal Surgery, AdventHealth, Orlando, FL, USA.
²⁰ Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
²¹ Complex Cancer and Exenterative Service, University Hospitals Southampton, Southampton, UK.
²² NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton, Southampton, UK.
²³ Long Island Jewish Medical Center and System Chief for Bariatric Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA.
²⁴ Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
²⁵ Innovative Surgical Techniques, Endoscopic and Endocrine Surgery, Department of Surgery, Maastricht University Medical Center, Amsterdam, Netherlands.
²⁶ Division of Nuclear Medicine, University of Torino, Turin, Italy.
²⁷ Department of Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK. n.francis@griffininstitute.org.uk.
²⁸ The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK. n.francis@griffininstitute.org.uk.

PMID: 38942944
PMCID: PMC11289045
DOI: 10.1007/s00464-024-10977-7

Practice Guideline

EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults

Deborah S Keller et al. Surg Endosc. 2024 Aug.

. 2024 Aug;38(8):4104-4126.

doi: 10.1007/s00464-024-10977-7. Epub 2024 Jun 28.

Authors

Affiliations

¹ Department of Digestive Surgery, University of Strasbourg, Strasbourg, FR, USA.
² Surgical Unit, Dorset County Hospital, Dorchester, Dorset, UK.
³ SAGES, Los Angeles, CA, USA.
⁴ Department of Surgical Sciences, University of Torino, Turin, Italy.
⁵ Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
⁶ Department of General and Minimally Invasive Surgery, Busto Arsizio Circolo Hospital, ASST-Valle Olona, Varese, Italy.
⁷ Department of General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece.
⁸ Department of Surgery, Queen's University, Kingston, ON, Canada.
⁹ Department of Surgery, University Hospital CHUV, Lausanne, Switzerland.
¹⁰ Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
¹¹ Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
¹² Department of Colorectal Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
¹³ Department of Clinical and Surgical Gastrointestinal Diseases, University of Naples "Federico II", Via Pansini 5, Naples, Italy.
¹⁴ Department of Surgery, Hellenic Red Cross Korgialeneio Benakeio NHS, Athens, Greece.
¹⁵ Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Campus and the Royal Marsden Hospital, London, UK.
¹⁶ Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
¹⁷ Department of Surgery, University of Florida, Jacksonville, FL, USA.
¹⁸ Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA.
¹⁹ Department of Colorectal Surgery, AdventHealth, Orlando, FL, USA.
²⁰ Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
²¹ Complex Cancer and Exenterative Service, University Hospitals Southampton, Southampton, UK.
²² NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton, Southampton, UK.
²³ Long Island Jewish Medical Center and System Chief for Bariatric Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA.
²⁴ Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
²⁵ Innovative Surgical Techniques, Endoscopic and Endocrine Surgery, Department of Surgery, Maastricht University Medical Center, Amsterdam, Netherlands.
²⁶ Division of Nuclear Medicine, University of Torino, Turin, Italy.
²⁷ Department of Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK. n.francis@griffininstitute.org.uk.
²⁸ The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK. n.francis@griffininstitute.org.uk.

PMID: 38942944
PMCID: PMC11289045
DOI: 10.1007/s00464-024-10977-7

Abstract

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.

Keywords: Abdominal Surgery; Elderly; Enhanced recovery after surgery (ERAS); Frail; Frailty; Laparoscopy; Older adults/aged; Perioperative care; Prehabilitation; Robotic surgical procedures.

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Conflict of interest statement

Al-Mansour—Medtronic honorarium; Abbvie honorarium; Intuitive surgery—educational payments; Gore general payments; Duval general payments. Leeds—Intuitive surgery—product development consultant. Deborah S Keller, Nathan Curtis, Holly Ann Burt, Carlo Alberto Ammirati, Amelia T Collings, Francisco Carrano, Stavros A. Antoniou, Nader Hanna, Laure-Meline Piotet, Sarah Hill, Anne CM Cuijpers, Patricia Tejedor, Marco Milone, Eleni Andriopoulou, Christos Kontovounisios, Ziad T Awad, Meghan Wandtke Barber, George Nassif, Malcolm A West, Aurora D Pryor, Franco Carli, Nicholas Demartines, Nicole D Bouvy, Roberto Passera, Alberto Arezzo, and Nader Francis have no conflicts of interest or financial ties to disclose.

References

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EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults

Affiliations

EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Research Materials