Objectives: ERAS programs have been shown to reduce time to full enteral feeding, postoperative medical morbidity, and postoperative hospital length of stay (LOS) in elective abdominal aortic aneurism (AAA) repair. The purpose of this historical cohort study was to evaluate the impact of an ERAS protocol applied to patients undergoing elective retroperitoneal AAA repair. Methods: An ERAS protocol based upon opioid sparing anesthesia-analgesia (thoracic epidural), early oral feeding and enforced mobilization was applied to patients undergoing elective retroperitoneal AAA repair since 2008. All patients (N=130) operated on in 2008-2013 (ERAS group) were compared to all patients (N=91) who underwent elective retroperitoneal AAA repair at the same institution in 2005-2007 (control group), before the introduction of ERAS methodology. Data were analyzed by intention to treat, using the chi-square, ANOVA, and Mann-Whitney tests as appropriate. P ≤ 0.05 was considered significant. Results: Demographics and ASA score distribution were comparable in-between groups. No difference could be detected in readmission rate ≤ 30 days (0 vs 3%, P=0.07). Outcome variables in between groups were as follows [Median (IQR 25-75)]: Variables ERAS group (N=130) Control group (N=91) P Admission in ICU 47 (36%) 61 (67%) <0.01 ICU length of stay (LOS) 0 (0-1) 1 (0-3) <0.01 Minor complications (Clavien I-II) 20 (15%) 52 (57%) <0.01 Major complications (Clavien III-IV) 4 (3%) 10 (11%) <0.02 In hospital mortality 3 (2%) 3 (3%) 0.48 Time to full enteral feeding (days) 3 (2-4) 4 (3-5) <0.01 Time to intestinal activity (days) 2 (1-3) 2 (2-3) <0.01 Time to bowel movements (days) 3 (2-4) 4 (3-5) <0.01 Postoperative LOS (days) 5 (4-7) 7 (6-9) <0.01 Conclusion: ERAS program in elective retroperitoneal AAA surgical repair significantly reduced morbidity, ICU admission and LOS, functional recovery, and postoperative LOS with no increase neither in mortality nor in the readmission rate.
The impact of an Enhanced Recovery After Surgery (ERAS) program in elective retroperitoneal abdominal aortic aneurism repair
FEO, Carlo;PORTINARI, Mattia;Targa, Simone;VOLTA, Carlo Alberto;
2014
Abstract
Objectives: ERAS programs have been shown to reduce time to full enteral feeding, postoperative medical morbidity, and postoperative hospital length of stay (LOS) in elective abdominal aortic aneurism (AAA) repair. The purpose of this historical cohort study was to evaluate the impact of an ERAS protocol applied to patients undergoing elective retroperitoneal AAA repair. Methods: An ERAS protocol based upon opioid sparing anesthesia-analgesia (thoracic epidural), early oral feeding and enforced mobilization was applied to patients undergoing elective retroperitoneal AAA repair since 2008. All patients (N=130) operated on in 2008-2013 (ERAS group) were compared to all patients (N=91) who underwent elective retroperitoneal AAA repair at the same institution in 2005-2007 (control group), before the introduction of ERAS methodology. Data were analyzed by intention to treat, using the chi-square, ANOVA, and Mann-Whitney tests as appropriate. P ≤ 0.05 was considered significant. Results: Demographics and ASA score distribution were comparable in-between groups. No difference could be detected in readmission rate ≤ 30 days (0 vs 3%, P=0.07). Outcome variables in between groups were as follows [Median (IQR 25-75)]: Variables ERAS group (N=130) Control group (N=91) P Admission in ICU 47 (36%) 61 (67%) <0.01 ICU length of stay (LOS) 0 (0-1) 1 (0-3) <0.01 Minor complications (Clavien I-II) 20 (15%) 52 (57%) <0.01 Major complications (Clavien III-IV) 4 (3%) 10 (11%) <0.02 In hospital mortality 3 (2%) 3 (3%) 0.48 Time to full enteral feeding (days) 3 (2-4) 4 (3-5) <0.01 Time to intestinal activity (days) 2 (1-3) 2 (2-3) <0.01 Time to bowel movements (days) 3 (2-4) 4 (3-5) <0.01 Postoperative LOS (days) 5 (4-7) 7 (6-9) <0.01 Conclusion: ERAS program in elective retroperitoneal AAA surgical repair significantly reduced morbidity, ICU admission and LOS, functional recovery, and postoperative LOS with no increase neither in mortality nor in the readmission rate.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
