Enhanced recovery after emergency surgery in the elderly

Life expectancy is still rising. It is crucial to examine the best perioperative treatment in detail in this older population in both elective and emergency settings. Despite the implementation of enhanced recovery after surgery (ERAS) and the continuous evolving of minimally invasive approach, the literature is still scarce in the application of these two approaches, in particular, when an emergency setting is considered. Data currently available show that elderly patients beneficiate from a perioperative ERAS pathway in terms of outcomes and that a high proportion of ERAS items for elective surgery could be applicable also in emergency surgery, with favorable outcomes in terms of postoperative complications, accelerated recovery of bowel function, and shorter postoperative hospital stay, without increasing for re-admission. The combination of laparoscopy and ERAS, in the elderly in elective setting, is safe and feasible with no adverse outcome. The simultaneous application of ERAS and laparoscopy in the elderly and emergency settings gave initial promising results in terms of safety and efficacy; however, we are far from drawing robust conclusion due to the paucity and the retrospective nature of data currently available. The heterogeneity of care among different centers and the objective difficulty in obtaining an appropriate preoperative patient selection are the main obstacles. An active participation and collaboration and the creation of tailored ERAS pathway including frailty assessment, specific discharge strategy, and ethical consideration in the context of a dedicated multidisciplinary international network could represent the next step to better clarify this issue.