Abstract
ObjectivesTo evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA).BackgroundOpen surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes.MethodsA review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI) are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied.ResultsThirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05].ConclusionThis review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.
Highlights
Elective open surgical repair of the abdominal aortic aneurysm (AAA) has been the most effective treatment to prevent its rupture when considering anatomically more complex aneurysms with a diameter greater than 5.5 cm
Thirteen case series studies with enhanced recovery after surgery (ERAS) involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients
The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% confidence interval (CI): 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05]
Summary
Elective open surgical repair of the abdominal aortic aneurysm (AAA) has been the most effective treatment to prevent its rupture when considering anatomically more complex aneurysms with a diameter greater than 5.5 cm. A more systematic perioperative approach targeting the reduction of costs and the improvement of outcomes, consisting of multimodal strategies has replaced conventional perioperative care These new strategies involve a combination of various different treatments, i.e., a reduced fasting time, less invasive surgical procedures, a better strategy for postoperative pain control, use of short-acting anesthetics, ileus control and the rational use of invasive monitoring and intensive care treatment [3]. These strategies have been adopted mainly for colorectal surgeries [4], and for nephrectomy [5], thyroidectomy [6] and hip arthroplasty [7] and are called enhanced recovery after surgery (ERAS) programs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
