Fast track aortic surgery: why not?

Abstract

We investigated the effects of the introduction of fast track aortic surgery in a vascular department. Methods. We conducted an 11 years retrospective analysis. We analyzed data from 2000 to 2010 on 758 patients undergoing elective open aortic surgery with a fast track pathway: minimally invasive surgery and anesthesia, early oral feeding and ambulation. This pathway inevitably influenced all patients pathways inside the department. We analyzed data of the whole department activity from 2003 to 2010. The mortality rate after aortic surgery was 1.98%, the morbidity rate 6.59% and the median postoperative length of stay 3 days. An overall analysis of the department performance underlined a progressive reduction in the mean hospital stay (8.18 in 2003 and 4.54 in 2010). This led to an increased turnover of patients and therefore to a rise of patients treated per year (756 in 2003 and 1070 in 2010), and to an increase of the economic reimbursement of about 40%. We met major internal obstacles, which led to an almost complete replacement of surgeons and nurses. There were neither economic nor image incentives for the team. There was no sponsorship by the local administration, which led to problems with the reimbursement from the Regional Health Service. The introduction of fast track aortic surgery has positively influenced the outcomes of patients treated for aortic diseases and the whole department performance. This revolution still meets considerable obstacles related to clinicians and administrators cultural shift.