In the rapidly evolving landscape of surgical care, the integration of enhanced recovery protocols is reshaping patient outcomes, particularly in the elderly population. A groundbreaking case report published in BMC Geriatrics by Ran and colleagues uncovers the profound potential of individualized Enhanced Recovery After Surgery (ERAS) protocols in managing complex surgeries for centenarians. This report centers on a 101-year-old patient who underwent a laparoscopic cholecystectomy, a minimally invasive procedure to remove the gallbladder, highlighting how tailored perioperative strategies can bolster physiological resilience despite advanced age.
Laparoscopic cholecystectomy has become the standard for treating symptomatic gallstones and cholecystitis due to its minimally invasive nature and faster recovery times. However, performing such surgeries on extremely elderly patients poses unique challenges, including diminished physiological reserves, multiple comorbidities, and heightened risk of complications. This case report is pioneering in its detailed description of implementing an individualized ERAS approach to mitigate these risks, shedding light on how surgical outcomes in nonagenarians and centenarians might be improved.
ERAS protocols, originally developed to minimize surgical stress and facilitate early recovery, encompass multimodal strategies addressing preoperative optimization, intraoperative management, and postoperative care. The intrinsic value of ERAS lies in its holistic approach that targets various stressors simultaneously, thus fostering faster functional recovery, decreasing hospital stays, and reducing postoperative complications. However, standard ERAS guidelines frequently require customization to accommodate the physiological nuances encountered in the oldest-old patients.
The 101-year-old patient’s journey through laparoscopic cholecystectomy with ERAS management exemplified meticulous attention to multiple facets of perioperative care. Preoperatively, comprehensive geriatric assessments were conducted to evaluate frailty, cognitive function, cardiopulmonary fitness, and nutritional status. These assessments guided individualized interventions, including tailored nutritional supplementation and physical conditioning aimed at enhancing physiological reserves. This step was crucial, given that chronological age alone is a poor predictor of surgical risk compared to biological age and functional status.
Intraoperative management emphasized minimally invasive techniques to limit surgical trauma and the stress response. The anesthesia protocol was adapted to minimize alterations in hemodynamics while ensuring optimal pain control without heavy sedation that could precipitate postoperative delirium. Additionally, environmental factors such as operating room temperature and normothermia maintenance were meticulously controlled to support homeostasis in the vulnerable centenarian patient.
Postoperative care under the ERAS model in this instance included early mobilization encouraged within hours following surgery, aggressive pain management strategies avoiding opioids when possible, and prompt initiation of enteral feeding to reduce catabolic states. Vital to this approach was the close monitoring of physiological markers of resilience, including inflammatory mediators, muscle strength, and mental status, to rapidly identify and address any deviations from expected recovery trajectories.
The case report underscores the concept of physiological resilience—an individual’s capacity to withstand and recover from the physiological stress imposed by surgery. In aged patients, this resilience is often compromised due to cumulative declines in organ function and systemic homeostasis. The ERAS framework, customized to the patient’s specific baseline status, appears to augment this resilience by reinforcing adaptive mechanisms and preventing maladaptive responses such as excessive inflammation or prolonged immobilization.
Advanced technologies were also leveraged, including noninvasive hemodynamic monitoring and wearable devices to continuously track activity levels and vital signs post-surgery. These innovations enabled precision medicine approaches, allowing clinicians to personalize interventions dynamically throughout the recovery process. This integration of modern technology with established ERAS principles is arguably a paradigm shift in managing frail elderly surgical patients.
The favorable outcome documented—a successful laparoscopic cholecystectomy with rapid functional recovery and no significant complications—challenges long-standing biases that advanced age is an absolute contraindication for elective minimally invasive surgeries. Instead, this experience reveals that the right combination of individualized ERAS measures and physiological vigilance can transform surgical risk profiles even at the extremes of age.
The authors also emphasize the psychological dimensions of recovery. The patient’s mental and emotional well-being, including confidence in the care team and clear communication about the surgical plan, were integral components of the ERAS approach. Psychosocial stability contributes significantly to physiological resilience by modulating stress responses and supporting rehabilitative efforts.
This case report opens avenues for future research aimed at refining ERAS protocols specifically for geriatric surgical patients and investigating molecular markers of resilience that could further personalize care. It also calls for multidisciplinary collaboration, involving surgeons, anesthesiologists, geriatricians, nutritionists, physiotherapists, and mental health professionals to address the complex needs of elderly patients holistically.
Moreover, health policy implications arise from recognizing that cost-effective, individualized ERAS interventions can reduce length of hospital stay and postoperative morbidity, thus easing the economic burden on healthcare systems facing rapidly aging populations. Training programs for surgical teams should integrate principles of geriatric care and resilience science to prepare a workforce capable of delivering these cutting-edge protocols.
Impressively, this centenarian’s successful surgery underlines the broader message that age alone does not define operative risk or recovery potential. When harnessed thoughtfully, the combination of minimally invasive technology, individualized ERAS pathways, and continuous physiological monitoring offers a new standard of care for elderly surgical patients. This holistic model embodies the future of surgery—patient-centric, precision-guided, and resilience-enhancing.
In summary, this compelling case report from Ran et al. challenges traditional perceptions about the limits of surgical intervention in extreme old age. It delivers a powerful narrative proof-of-concept that individualized ERAS pathways can not only safely enable complex surgeries in centenarians but also actively foster physiological resilience, paving the way for improved quality of life postoperatively. As global longevity increases, such pioneering work will be instrumental in redefining surgical care paradigms and expanding the therapeutic horizons for elderly patients worldwide.
Subject of Research:
Individualized Enhanced Recovery After Surgery (ERAS) protocols and physiological resilience in elderly surgical patients.
Article Title:
Individualized Enhanced Recovery After Surgery (ERAS) and physiological resilience in a 101-year-old patient undergoing laparoscopic cholecystectomy: a case report.
Article References:
Ran, R., Chen, L., Wu, J. et al. Individualized Enhanced Recovery After Surgery (ERAS) and physiological resilience in a 101-year-old patient undergoing laparoscopic cholecystectomy: a case report. BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07454-2
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