In predefined subgroup analyses , findings did not vary by surgical approach ( open vs laparoscopic ) or colorectal condition .
CONCLUSIONS : Enhanced recovery protocol s for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events .
Evidence was insufficient regarding which components , or component combinations , are key to improving patient outcomes .
BACKGROUND : Enhanced surgical recovery protocol s are design ed to reduce hospital length of stay and health care costs .
OBJECTIVE : This study aims to systematic ally review and summarize evidence from r and omized and controlled clinical trials comparing enhanced recovery protocol s versus usual care in  adults undergoing elective colorectal surgery with emphasis on recent trials , protocol components , and subgroups for surgical approach and colorectal condition .
Fast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma
Objective This study aims to investigate the role of fast-track surgery in preventing the development of postoperative delirium and other complications in elderly patients with colorectal carcinoma . Methods A total of 240 elderly patients with colorectal carcinoma ( aged ≥70 years ) undergoing open colorectal surgery was r and omly assigned into two groups , in which the patients were managed perioperatively either with traditional or fast-track approaches . The length of hospital stay ( LOS ) and time to pass flatus were compared . The incidence of postoperative delirium and other complications were evaluated . Serum interleukin-6 ( IL-6 ) levels were determined before and after surgery . Results The LOS was significantly shorter in the fast-track surgery ( FTS ) group than that in the traditional group . The recovery of bowel movement ( as indicated by the time to pass flatus ) was faster in the FTS group . The postoperative complications including pulmonary infection , urinary infection and heart failure were significantly less frequent in the FTS group . Notably , the incidence of postoperative delirium was significantly lower in patients with the fast track therapy ( 4/117 , 3.4 % ) than with the traditional therapy ( 15/116 , 12.9 % ; p = 0.008 ) . The serum IL-6 levels on postoperative days 1 , 2 , and 3 in patients with the fast-track therapy were significantly lower than those with the traditional therapy ( p < 0.001 ) . Conclusions Compared to traditional perioperative management , fast-track surgery  decreases the LOS , facilitates the recovery of bowel movement , and reduces occurrence of postoperative delirium and other complications in elderly patients with colorectal carcinoma . The lower incidence of delirium is at least partly attributable to the reduced systemic inflammatory response mediated by IL-6
In predefined subgroup analyses , findings did not vary by surgical approach ( open vs laparoscopic ) or colorectal condition .
CONCLUSIONS : Enhanced recovery protocol s for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events .
Evidence was insufficient regarding which components , or component combinations , are key to improving patient outcomes .
BACKGROUND : Enhanced surgical recovery protocol s are design ed to reduce hospital length of stay and health care costs .
OBJECTIVE : This study aims to systematic ally review and summarize evidence from r and omized and controlled clinical trials comparing enhanced recovery protocol s versus usual care in  adults undergoing elective colorectal surgery with emphasis on recent trials , protocol components , and subgroups for surgical approach and colorectal condition .