Published in:
01-05-2008 | Evidence-based Surgery
Prospective randomized controlled trial to evaluate “fast-track” elective open infrarenal aneurysm repair
Published in: Langenbeck's Archives of Surgery | Issue 3/2008
Login to get accessAbstract
Background and aims
Fast-track programs have been introduced in many surgical fields to minimize postoperative morbidity and mortality. Morbidity after elective open infrarenal aneurysm repair is as high as 30%; mortality ranges up to 10%. In terms of open infrarenal aneurysm repair, no randomized controlled trials exist to introduce and evaluate such patient care programs.
Materials and methods
This study involved prospective randomization of 82 patients in a “traditional” and a “fast-track” treatment arm. Main differences consisted in preoperative bowel washout (none vs. 3 l cleaning solution) and analgesia (patient controlled analgesia vs. patient controlled epidural analgesia). Study endpoints were morbidity and mortality, need for postoperative mechanical ventilation, and length of stay (LOS) on intensive care unit (ICU).
Results
The need for assisted postoperative ventilation was significantly higher in the traditional group (33.3% vs. 5.4%; p = 0.011). Median LOS on ICU was shorter in the fast-track group, 41 vs. 20 h. The rate of postoperative medical complications was significantly lower in the fast-track group, 16.2% vs. 35.7% (p = 0.045).
Conclusion
We introduced and evaluated an optimized patient care program for patients undergoing open infrarenal aortic aneurysm repair which showed a significant advantage for “fast-track” patients in terms of postoperative morbidity.