The Fast Truck In Elderly Patients Undergoing Colorectal Surgery:A Meta-analysis Of Randomized Controlled Trial

Objective:Fast-track rehabilitation in surgery(FTS)programs have been proved to be useful for the patients undergoing colorectal surgery.However,benefits of the FTS in the elderly patients are less certain.The purpose of this study was to estimate the security and practicability of the FTS protocol in elderly patients undergoing colorectal surgery.Methods:PubMed,Embase,Web of science,Cochrane Library databases,China National Knowledge Infrastructure(CNKI)and Wangfang Data Knowledge Service Platform were searched for all randomized controlled trials comparing the FTS program with conventional care in elderly patients undergoing colorectal surgery.Databases to identify relevant articles from January 1996 to September 2018.The following search terms were used,in all possible combinations:“fast track surgery(FTS)program”,“enhanced recovery after surgery(ERAS)”,“colorectal cancer”,“surgery”and“ elderly patient ”.The main outcome measure was time to first flatus,the first landing time ? length of hospital stay,total hospitalization costs and the overall complications.The meta-analysis was performed using RevMan 5.3 software.Results:There were included nine randomized controlled trials with 817 elderly patients(417 FTS and 400 traditional protocols)in the analysis.Compared with conventional care,FTS projects could significantly reduce the Intestinal function recovery time[MD=–24.83,95%CI(–38.99,–10.68),P=0.0006],the first feeding time[MD=–41.52,95%CI(–62.57,–20.46),P=0.0001],the first landing time[MD=–11.07,95%CI(–15.36,–6.77),P<0.00001],total length of stay [MD=–2.79,95%CI(–3.73,–1.84),P<0.00001]and decrease the overall complications [ OR=0.33,95%CI(0.23,0.47),P <0.00001].However,with no significant differences in the total hospitalization costs[MD=–0.75,95%CI(–1.90,0.39),P=0.2].Conclusions:Fast-track after colorectal surgery can be safely and beneficial applied to the elderly patients older than age 65 years.Further larger studies with high quality RCTs are needed to assess the long-term outcomes.