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1Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
3Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
Copyright © 2022 The Korean Society of Coloproctology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
Modified from Kim et al. [7], according to the Creative Commons License.
Protocol | |
---|---|
Preoperative | 1. Preadmission patient counseling |
2. Preoperative oral carbohydrate treatment | |
3. Preoperative formula intake | |
4. Thromboembolism prophylaxis | |
5. Prophylactic antibiotics | |
Intraoperative | 6. Epidural or spinal anesthesia |
7. Hypothermia prophylaxis | |
8. Restrictive fluid strategy | |
9. Postoperative nausea and vomiting prophylaxis | |
Postoperative | 10. Postoperative epidural analgesia |
11. Multimodal opioid-sparing pain control | |
12. Near-zero fluid balance | |
13. Chewing gum (stimulation of gut motility I) | |
14. Laxative (stimulation of gut motility II) | |
15. Early urinary catheter removal (before postoperative day 3) | |
16. Early surgical drainage removal (before postoperative day 3) | |
17. Termination of intravenous fluid infusion (before postoperative day 3) | |
18. Early mobilization on day of surgery | |
19. Early mobilization on postoperative day 1 | |
20. Early mobilization on postoperative day 2 | |
21. Early mobilization on postoperative day 3 | |
22. Oral intake on day of surgery | |
23. Oral intake on postoperative day 1 |
Characteristic | YG (≤70 yr) (n=237) | OG (>70 yr) (n=98) | P-value |
---|---|---|---|
Age (yr) | 57.6 ± 8.7 | 78.2 ± 4.7 | < 0.001 |
Sex | 0.229 | ||
Male | 145 (61.2) | 53 (54.1) | |
Female | 92 (38.8) | 45 (45.9) | |
Body mass index (kg/m2) | 24.1 ± 3.3 | 22.9 ± 3.2 | 0.003 |
Smoking | 0.001 | ||
Yes | 75 (31.6) | 14 (14.3) | |
No | 162 (68.4) | 84 (85.7) | |
Comorbidity | |||
Hypertension | 72 (30.4) | 52 (53.1) | < 0.001 |
Diabetes | 29 (12.2) | 24 (24.5) | 0.005 |
Cardiovascular | 9 (3.8) | 10 (10.2) | 0.021 |
Cerebrovascular | 2 (0.8) | 2 (2.0) | 0.359 |
COPD | 1 (0.4) | 3 (3.1) | 0.043 |
Hepatitis | 15 (6.3) | 5 (5.1) | 0.666 |
ASA PS classification, ≥ III | 4 (1.7) | 5 (5.1) | 0.079 |
Tumor location | 0.060 | ||
Colon | 162 (68.4) | 77 (78.6) | |
Rectum | 75 (31.6) | 21 (21.4) | |
Obstruction | 0.443 | ||
Yes | 40 (16.9) | 20 (20.4) | |
No | 197 (83.1) | 78 (79.6) | |
Approach | 0.147 | ||
Laparoscopic | 193 (81.4) | 86 (87.8) | |
Robotic | 35 (14.8) | 7 (7.1) | |
Open | 9 (3.8) | 5 (5.1) | |
Preoperative CRP | 0.7 ± 1.7 | 1.0 ± 2.4 | 0.196 |
Variable | YG (≤ 70 yr) (n = 237) | OG (> 70 yr) (n = 98) | P-value |
---|---|---|---|
TNM stage | 0.264 | ||
I+ II | 115 (48.5) | 41 (41.8) | |
III + IV | 122 (51.5) | 57 (58.2) | |
Stoma formation | 0.057 | ||
Yes | 53 (22.4) | 13 (13.3) | |
No | 184 (77.6) | 85 (86.7) | |
Other organ resection | 0.931 | ||
Yes | 33 (13.9) | 14 (14.3) | |
No | 204 (86.1) | 84 (85.7) | |
Operation time (min) | 215 ± 100.6 | 189 ± 88.4 | 0.023 |
Transfusion | 0.772 | ||
Yes | 14 (5.9) | 5 (5.1) | |
No | 223 (94.1) | 93 (94.9) | |
Radical resection | 0.471 | ||
R0 | 217 (91.6) | 92 (93.9) | |
≥ R1 | 20 (8.4) | 6 (6.1) | |
CRP POD 3–4 | 7.4 ± 5.8 | 7.7 ± 6.8 | 0.746 |
Length of stay (day) | 5 (5–7) | 5 (5–7) | 0.320 |
Readmission | 18 (7.6) | 4 (4.1) | 0.238 |
CCI score | 8.0 ± 13.2 | 11.7 ± 23.0 | 0.130 |
Variable | Overall |
YG (≤ 70 yr) |
OG (> 70 yr) |
|||||||
---|---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | P-value | OR | 95% CI | P-value | OR | 95% CI | P-value | ||
Age, > 70 yr | 1.297 | 0.634–2.653 | 0.477 | |||||||
Sex, female/male | 0.553 | 0.264–1.156 | 0.115 | 0.717 | 0.296–1.736 | 0.461 | 0.307 | 0.079–1.195 | 0.089 | |
BMI, ≥ 25 kg/m2 | 1.727 | 0.866–3.445 | 0.121 | 2.505 | 1.084–5.789 | 0.032 | 0.763 | 0.193–3.013 | 0.699 | |
ASA PS classification, ≥ III | 2.302 | 0.460–11.505 | 0.310 | 2.903 | 0.290–29.018 | 0.364 | 1.688 | 0.174–16.393 | 0.652 | |
Obstruction, yes/no | 3.183 | 1.534–6.607 | 0.002 | 2.647 | 1.054–6.646 | 0.038 | 4.347 | 1.268–14.900 | 0.019 | |
Approach | ||||||||||
Laparoscopic | Reference | Reference | Reference | |||||||
Robotic | 2.290 | 0.960–5.463 | 0.062 | 2.142 | 0.780–5.882 | 0.139 | 3.422 | 0.578–20.278 | 0.175 | |
Open | 3.892 | 1.140–13.287 | 0.030 | 2.958 | 0.569–15.378 | 0.197 | 5.704 | 0.838–38.819 | 0.075 | |
Stomy formation, yes/no | 1.537 | 0.706–3.347 | 0.279 | 1.403 | 0.553–3.564 | 0.476 | 2.250 | 0.528–9.584 | 0.273 | |
Other organ resection, yes/no | 2.115 | 0.930–4.811 | 0.074 | 2.164 | 0.794–5.898 | 0.131 | 2.018 | 0.479–8.495 | 0.338 | |
Operation time | 1.005 | 1.002–1.008 | 0.001 | 1.006 | 1.003–1.010 | 0.001 | 1.003 | 0.997–1.009 | 0.264 | |
Transfusion, yes/no | 3.063 | 1.037–9.045 | 0.043 | 3.848 | 1.109–13.343 | 0.034 | 1.688 | 0.174–16.393 | 0.652 | |
CRP POD 3–4 | 1.148 | 1.088–1.211 | < 0.001 | 1.135 | 1.062–1.213 | < 0.001 | 1.171 | 1.067–1.285 | 0.001 |
Variable | Overall |
YG (≤ 70 yr) |
OG (> 70 yr) |
|||||||
---|---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | P-value | OR | 95% CI | P-value | OR | 95% CI | P-value | ||
Age, > 70 yr | ||||||||||
Sex, female/male | 0.642 | 0.132–3.119 | 0.583 | |||||||
BMI, ≥ 25 kg/m2 | 3.151 | 1.199–8.276 | 0.020 | |||||||
ASA PS classification, ≥ III | ||||||||||
Obstruction, yes/no | 3.355 | 1.407–7.999 | 0.006 | 4.159 | 1.429–12.107 | 0.009 | 4.736 | 0.760–29.501 | 0.096 | |
Approach | ||||||||||
Laparoscopic | ||||||||||
Robotic | 2.017 | 0.684–5.946 | 0.203 | |||||||
Open | 1.423 | 0.335–6.056 | 0.633 | 2.315 | 0.187–28.690 | 0.513 | ||||
Stomy formation, yes/no | ||||||||||
Other organ resection, yes/no | 1.045 | 0.361–3.026 | 0.935 | |||||||
Operation time | 1.284 | 0.527–3.126 | 0.583 | 2.219 | 0.799–6.164 | 0.126 | ||||
Transfusion, yes/no | 2.258 | 0.623–8.179 | 0.215 | 2.802 | 0.713–11.018 | 0.140 | ||||
CRP POD 3–4 | 1.756 | 0.804–3.836 | 0.158 | 0.930 | 0.359–2.411 | 0.882 | 6.079 | 1.117–33.076 | 0.037 |
Modified from Kim et al. [
Values are presented as mean±standard deviation or number (%). YG, young group; OG, old group; COPD, chronic obstructive pulmonary disease; ASA, American Society of Anesthesiologists; PS, physical status; CRP, C-reactive protein.
Values are presented as number (%), mean±standard deviation, or median (interquartile range). YG, young group; OG, old group; CRP, C-reactive protein; POD, postoperative day; CCI, comprehensive complication index.
YG, young group; OG, old group; OR, odds ratio; CI, confidence interval; BMI, body mass index; ASA, American Society of Anesthesiologists; PS, physical status; CRP, C-reactive protein; POD, postoperative day.
YG, young group; OG, old group; OR, odds ratio; CI, confidence interval; BMI, body mass index; ASA, American Society of Anesthesiologists; PS, physical status; CRP, C-reactive protein; POD, postoperative day.