Application of remimazolam anesthesia in elderly patients undergoing radical resection for colorectal cancer: a cohort study on gastrointestinal recovery and complication rates
TL;DR
For elderly patients undergoing colorectal cancer surgery within an ERAS pathway, remimazolam anesthesia was associated with shorter gastrointestinal recovery times, lower observed rates of selected postoperative complications, and higher QoR-15 scores compared with propofol.
Abstract
Background Optimizing anesthesia within the enhanced recovery after surgery (ERAS) protocol was crucial for elderly patients undergoing radical resection for colorectal cancer. This study aimed to assess the impact of remimazolam versus propofol anesthesia on postoperative gastrointestinal function recovery and complication rates in this population. Methods This prospective cohort study included elderly patients who underwent radical cancer resection from January 2023 to January 2025. Patients were assigned to either the remimazolam group or the propofol group based on the anesthetic used. Gastrointestinal hormones were measured preoperatively and 24 hours postoperatively. Recovery times for bowel sounds, first flatus, first defecation, and first solid food intake were recorded. Postoperative complications, including nausea/vomiting and delirium, were monitored, and recovery quality was assessed using the QoR-15 scale one week postoperatively. Results After propensity score matching, 243 patients were analyzed (remimazolam: n=115; propofol: n=128). At 24 hours postoperatively, motilin (81.47 ± 5.13 pg/mL vs. 79.61 ± 5.62 pg/mL, P = 0.008) and gastrin levels (48.25 ± 5.88 pg/mL vs. 42.72 ± 6.41 pg/mL) were higher in the remimazolam group. The remimazolam group showed shorter gastrointestinal recovery times (all P<0.05). Nausea/vomiting (5.22% vs. 13.28%, P = 0.032) and delirium (10.43% vs. 21.88%, P = 0.016) rates were lower, and QoR-15 scores were higher (125.44 ± 9.95 vs. 119.89 ± 12.82, P<0.001) compared to the propofol group. Conclusion For elderly patients undergoing colorectal cancer surgery within an ERAS pathway, remimazolam anesthesia was associated with shorter gastrointestinal recovery times, lower observed rates of selected postoperative complications, and higher QoR-15 scores compared with propofol. Given the prospective cohort design, these findings should be interpreted as associations rather than evidence of causality and require confirmation in randomized studies.