ORIGINAL ARTICLE Enhanced Recovery Program for Colorectal Surgery: a Focus on Elderly Patients Over 75 Years Old Maria Carmen Lirosi 1 & Flavio Tirelli 1 & Alberto Biondi 1 & Maria Cristina Mele 2,3 & Cristina Larotonda 1 & Laura Lorenzon 1 & Domenico D’Ugo 1,3 & Antonio Gasbarrini 3,4 & Roberto Persiani 1,3 Received: 9 February 2018 /Accepted: 20 August 2018 # 2018 The Society for Surgery of the Alimentary Tract Abstract Background An enhanced recovery after surgery (ERAS) protocol can effectively improve perioperative outcomes in surgical patients by reducing complication rates and hospital stay. However, its application in elderly patients has yielded contradictory results. The aim of this study was to evaluate surgical outcomes in a cohort of elderly patients undergoing colorectal resection in our unit before and after the introduction of ERAS. Methods From 328 patients undergoing colorectal surgery in our unit over a 2-year period (2015–2016), 114 patients ≥ 75 years of age were selected. The patients were categorized according to perioperative treatment as pre-ERAS and ERAS patients (respectively, 53 vs 61 patients), and the groups were compared for statistical purposes. Outcome measures included length of hospital stay, recovery of bowel functions, oral feeding, postoperative complications, and readmissions. Compliance with the ERAS protocol was also measured. Results Groups were homogeneous for all the clinical-surgical variables, with the sole exception of the Charlson index, which was more severe in the ERAS group (p = 0.012). Compared with control patients, ERAS patients reported improved functional recovery (time to first flatus, stool, and oral feeding; p < 0.001). Hospital stay was reduced in ERAS patients overall and by side of resection, excluding rectal procedures. No differences were observed regarding postoperative complications. Of note, an optimal adherence to the protocol was reported, with 79% of items respected. Conclusions ERAS can be considered safe in elderly patients undergoing colorectal surgery with a high comorbidity index, providing a reduction in hospital stay and improving short-term postoperative outcomes. Finally, the protocol application was feasible, with a high adherence to the items in this subset of patients. Keywords Enhanced recovery after surgery . ERAS . Colorectal surgery . Elderly patients . Outcomes Introduction Initially proposed by Professor Henrik Khelet in Denmark, enhanced recovery after surgery (ERAS) is a multidisciplinary program of care delivered to patients in order to obtain a rapid recovery after surgical interventions. 1,2 To date, a number of studies have widely documented that fast-track rehabilitation could improve perioperative manage- ment by reducing stress and postoperative complications, shortening the length of hospital stay, and reducing health- related costs. 3–6 Current fast-track protocols combine multidisciplinary perioperative care strategies, including no pre-operative me- chanical bowel preparation, a minimal number of invasive tests, short-acting anesthetics, adequate perioperative fluid management, postoperative analgesia, early oral feeding, early * Flavio Tirelli tirelliflavio@gmail.com 1 Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC di Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy 2 Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC di Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy 3 Università Cattolica del Sacro Cuore, Milano, Italy 4 Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy Journal of Gastrointestinal Surgery https://doi.org/10.1007/s11605-018-3943-2