To evaluate the effects of ERAS(enhanced recovery after surgery) on postoperative hospitalization time, complications and total cost in the elderly who underwent pulmonary surgery.

Retrospective analysis was performed on effects of enhanced recovery after surgery on the elderly who underwent pulmonary surgery between 1999 and 2016. A total of 194 patients with the median age of 76 (75 to 78) years old were included. Based on the completion ratio of ERAS in the perioperative treatments, they were divided into three groups. Group A: ≤33% of all the ERAS measures were completed among the patients (81 cases); Group B: 33%-50% of all the ERAS measures were completed (54 cases); Group C: ≥50% of all the ERAS measures were completed among the patients(59 cases). Postoperative complications, postoperative hospital stay, and the total cost were analyzed. The differences between postoperative hospital stay, complication rates, and hospitalization costs were analyzed between groups with univariate analysis. Multivariate analysis was used to explore the potential risk factors of these clinical outcomes.

Postoperative complication ratio was significantly higher in group A when compared with group B and C (P<0.01). Postoperative hospital stay was longer in group A when compared with group B and C (P<0.01). Total cost was more expensive in group A when compared with group B and C(P<0.01). Univariate analysis showed gender, smoking history, surgery type, surgery duration, intraoperative blood loss, ERAS completion ratio and postoperative complication ratio were all risk factors of postoperative complications (P<0.05). Gender, pulmonary, ASA score, operation, surgery duration, intraoperative blood loss, and ERAS completion ratio were all risk factors of total cost(P<0.05). Binary logistic regression showed gender and surgery duration were risk factors of postoperative complications(HR=0.207, 95% CI: 0.086-0.495, P<0.001; HR=1.346, 95% CI: 1.095-1.654, P=0.005). Linear regression showed ERAS completion ratio was the only risk factor of postoperative hospital stay(β=-3.933, 95% CI: -5.975~-1.892, P<0.001=. Gender was the only risk factor of total cost(β=-1.171, 95%CI: -2.312~-0.031, P=0.044).

The implementation of ERAS in the elderly can reduce postoperative hospital stay.