***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Elderly patients often are regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities . The goal of this study was to compare the cost of care and short-term outcomes of elderly and nonelderly patients undergoing laparoscopic colectomy .  Our hypothesis was that elderly patients managed with  laparoscopic colorectal surgery and an enhanced recovery protocol ( ERP ) can realize the same benefits of lower hospital length of stay ( LOS ) without increasing hospital costs or readmission rates . Methods Review of a prospect i ve data base identified all patients that underwent an elective laparoscopic colectomy from 2009 to 2012 . Patients were stratified into elderly ( ≥70 years old ) and nonelderly ( < 70 years old ) cohorts . The main outcome measures were discharge disposition , hospital costs , hospital LOS , and 30-day readmission rates between the laparoscopic and open groups . Results A total of 302 nonelderly ( 66 % ) and 153 elderly ( 34 % ) patients were included in the analysis . The elderly cohort had significantly higher comorbidities than the nonelderly group . There were no mortalities . Operative variables ( procedure time , blood loss , and intraoperative complications ) were similar . At discharge , significantly more elderly patients required temporary nursing or home care . There were no significant differences in short-term outcomes of LOS , 30-day readmission rates , or costs for the episode of care between the two groups . Conclusions Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients . Despite higher comorbidities , elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates Objective Optimizing peri‐operative care using an enhanced recovery programme improves short‐term outcomes following colonic resection . This study compared a prospect i ve group of patients undergoing resection of colorectal cancer within an enhanced recovery programme , with a prospect ively studied historic cohort receiving conventional care The risks and benefits of surgery for colorectal cancer in old patients have not been unequivocally defined . The present investigation was carried out in 309 hospitals as a prospect i ve multicenter study . In the period between 1 January 2000 and 31 December 2001 , a total of 19,080 patients were recruited for the study ; 16,142 ( 84.6 % ) patients were younger than 80 years ( < 80 ) and 2932 ( 15.4 % ) were 80 years and older ( ≥ 80 ) . Significant differences between the age groups were observed for general postoperative complications ( 22.3 % for < 80 years ; 33.9 % for ≥ 80 ) . Specific postoperative complications were identical in both groups . Overall , significantly elevated morbidity and mortality rates were found with increasing age ( morbidity : 33.9 % vs. 43.5 % ; mortality : 2.6 % vs. 8.0 % ) . The distribution of tumor stages revealed a significantly higher percentage of locally advanced tumors in the older age group ( stage II : 28.0 % vs. 34.4 % ) . In contrast , no increase in metastasizing tumors was found in the older age group ( stage IV : 17.4 % vs. 14.1 % ) . Logistic regression showed that , in concert with a number of other parameters , age is a significant influencing factor on postoperative morbidity and mortality . The increase in postoperative morbidity and mortality rates associated with aging is a result of the increase in general postoperative complications , in particular , pneumonia and cardiovascular complications . Age as such does not represent a contraindication for surgical treatment . The short-term outcome and quality of life are of overriding importance for the geriatric patient Background This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery , and to provide grade d recommendations for items for an evidence d-based enhanced recovery protocol . Methods Studies were selected with particular attention paid to meta-analyses , r and omized controlled trials and large prospect i ve cohorts . For each item of the perioperative treatment pathway , available English- language literature was examined , review ed and grade d. A consensus recommendation was reached after critical appraisal of the literature by the group . Results For most of the protocol items , recommendations are based on good- quality trials or meta-analyses of good- quality trials ( evidence grade : high or moderate ) . Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway , the Enhanced Recovery After Surgery ( ERAS ) Society , European Society for Clinical Nutrition and Metabolism ( ESPEN ) and International Association for Surgical Metabolism and Nutrition ( IASMEN ) present a comprehensive evidence -based consensus review of perioperative care for rectal surgery Introduction Fast-track protocol s , introduced in the late 1990s , have been applied in several surgical fields , particularly for colorectal surgery . However , currently many surgical patients are elderly , and discussion about the application of such programs for elderly patients is lacking . The present study was design ed to assess the safety of application of a fast-track program after laparoscopic colorectal surgery in elderly patients . Methods From August 2009 to January 2011 , we prospect ively collected data from patients who underwent laparoscopic colorectal surgery with a perioperative fast-track program .  The data of patients older and younger than 70 years were compared . Results Of a total of 337 patients , the group of patients older than 70 years ( OG ) totaled 87 ( 25.8 % ) and the younger group ( YG ) totaled 250 ( 74.2 % ) . Ten patients ( 11.5 % ) were excluded in the OG and 24 ( 9.6 % ) in the YG . There were no differences in gender , history of previous surgeries , body mass index , type of operation , operative time , or blood loss between groups . Age ( 74.8 vs. 56.7 years , p < 0.001 ) , presence of comorbidities ( 70.1 vs. 44.7 % , p < 0.001 ) , and ASA score ( I : II : III , 33.8:57.1:9.1 vs. 60.6:33.2:6.2 % , p < 0.001 ) were significantly different between the two groups . Postoperative course did not show differences , including return of flatus , stool passage , advancement of diet , removal of urinary catheter , length of usage of IV antibiotics , complications , and length of postoperative stay . Emergency department visits or readmission within a month after discharge were more frequent in the OG ( 11.7 % ) than the YG ( 4 % ; p = 0.013 ) . Conclusions Fast-track after laparoscopic colorectal surgery can be safely applied in carefully selected elderly patients older than age 70 years . Physicians should keep in mind complications that may present after discharge and should actively educate patients about them Background and aims Evidence demonstrating improved short-term outcomes with laparoscopic surgery compared with open surgery for colorectal cancer is accumulating . In addition , programmes optimising peri-operative care for major abdominal surgery are becoming widespread . Evaluating laparoscopic surgery and enhanced recovery programmes usually focuses on short-term recovery . The aim of this study was to compare recovery after laparoscopic and open surgery for colorectal cancer up to 1 year post-operatively , using a combination of self-report and observer data . Patients / Methods From January 2002 to March 2004 , 62 patients were r and omised ( 2:1 ) to receive laparoscopic ( n = 43 ) or open surgery ( n = 19 ) within an enhanced recovery programme .  Functional outcomes up to 1 year were assessed using interview-administered question naires . Results / Findings Question naire and health-related quality of life data were obtained in over 85 % of patients . Patients undergoing laparoscopic surgery  felt fully recovered and resumed driving more quickly than those having open surgery ( p = 0.016 and p = 0.048 respectively ) . Fifty-eight percent of patients having open surgery felt fully recovered by 12 months versus 88 % of laparoscopic patients .Interpretation/ Conclusion Within an enhanced recovery programme , patients undergoing laparoscopic surgery  recovered more quickly than after open resection . Both approaches however , were associated with slow recovery despite a relatively short hospital stay Background The enhanced recovery program ( ERP ) aims to reduce the metabolic response to surgery , hastening recovery and shortening hospital stay . Concerns exist regarding morbidity and hospital stay in elderly patients . The present study aim ed to compare the outcomes and compliance of elderly patients managed by an ERP protocol with a younger group . Methods A review was performed of a prospect i ve data base of patients undergoing colorectal resection managed under the ERP protocol between 2005 and 2010 . Patients were grouped into < 80 years and ≥80 years , and perioperative data were collated . The postoperative outcomes were compared with the goals set out by the ERP protocol . Results A total of 688 patients were included , 558 were < 80 years ( median : 66 years ; range : 17–79 years ) and 130 were ≥80 years ( median : 83 years ; range : 80–95 years ) . Some 96 % of operations were planned laparoscopically . Median total length of hospital stay was 6 days ( range : 1–108 days ) for the < 80 year group and 8 days ( range : 1–167 days ; P 0.363 ) for the elderly group , with a 30 day readmission rate of 8.6 % for the population and no significant differences between groups . The 30 day mortality was 5 % , with a significant difference between the two groups ( P < 0.0001 ) . Differences in protocol adherence were identified in the discontinuation of intravenous fluids , catheter removal , and early mobilization . Conclusions An enhanced recovery program is feasible for colorectal surgery patients ≥80 years of age , with similar compliance as the younger group to some aspects of the protocol and an acceptable readmission rate . Attention to improving compliance in the postoperative phase is necessary , particularly in such high-risk patients , as such improvement may reduce the morbidity and mortality BACKGROUND older people undergoing elective surgery have significant post-operative problems prolonging hospitalisation . OBJECTIVE to design , embed , and evaluate an evidence -based comprehensive geriatric assessment ( CGA ) service for at-risk older patients undergoing elective surgery . SETTING urban teaching hospital . SUBJECTS elective surgical patients aged 65 + . INTERVENTION multidisciplinary preoperative CGA service with post-operative follow-through ( proactive care of older people undergoing surgery [ ' POPS ' ] ) . METHODS observational cohort study and multilevel surveys ( development and modelling phase ) . Prospect i ve ' before and after ' comparison ( exploratory evaluation ) . RESULTS findings from the development phase showed high levels of preoperative co-morbidity , no multidisciplinary preoperative input , and multiple potentially preventable post-operative problems delaying discharge in older elective surgery patients . Comparison of 2 cohorts of elective orthopaedic patients ( pre-POPS vs POPS , N = 54 ) showed the POPS group had fewer post-operative medical complications including pneumonia ( 20 % vs 4 % [ p = 0.008 ] ) and delirium ( 19 % vs 6 % [ p = 0.036 ] ) , and significant improvements in areas reflecting multidisciplinary practice including pressure sores ( 19 % vs 4 % [ p = 0.028 ] ) , poor pain control ( 30 % vs 2 % [ p<0.001 ] ) , delayed mobilisation ( 28 % vs 9 % [ p = 0.012 ] ) and inappropriate catheter use ( 20 % vs 7 % [ p = 0.046 ] ) . Length of stay was reduced by 4.5 days . There were fewer delayed discharges relating to medical complications ( 37 % vs 13 % ) or waits for OT assessment or equipment ( 20 % vs 4 % ) . CONCLUSION a proactive evidence -based CGA service for at-risk older elective surgical patients was developed according to MRC framework for complex interventions . Pre/post comparison in elective orthopaedic patients showed improved ( within method ological limitations ) post-operative outcomes indicative of better clinical effectiveness and efficiency , and contributed to the service obtaining mainstream funding . Informed by the present study , a r and omised controlled trial is ongoing Bilateral  simultaneous total knee replacement ( TKR )  has been considered by some to be associated with increased morbidity and mortality . Our study analysed the outcome of 150 consecutive , but selected , bilateral simultaneous TKRs  and compared them with that of 271 unilateral TKRs in a st and ardised fast-track setting . The procedures were performed between 2003 and 2009 . Apart from staying longer in hospital ( mean 4.7 days ( 2 to 16 ) versus 3.3 days ( 1 to 25 ) ) and requiring more blood transfusions , the outcome at three months and two years was similar or better in the bilateral  simultaneous TKR  group in regard to morbidity , mortality , satisfaction , the range of movement , pain , the use of a walking aid and the ability to return to work and to perform activities of daily living .  Bilateral simultaneous TKR can therefore be performed as a 
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The majority of observational studies did not show differences in outcome between elderly and younger patients  in terms of hospital stay , morbidity or mortality .
Inconsistent findings between cohort studies may reflect the disparities in ERAS protocol definitions or differences in study population s. CONCLUSION ERAS can be safely applied to elderly patients  to reduce complications and shorten length of hospital stay .
Further studies are required to assess whether elderly patients are able to adhere to , and benefit from , ERAS protocol s to the same extent as younger patients