«Fast track» in der Aneurysmachirurgie — erste Ergebnisse einer prospektiven, randomisierten und kontrollierten Studie

Abstract

Background: Despite advances in perioperative patient care major surgical procedures are still associated with certain morbidity and mortality. Open abdominal aortic aneurysm repair is related to morbidity up to 30 % and mortality up to 10 %. Further improvements by single interventions seem not to be possible. As a consequence multimodal concepts, i.e. fast track programs, have been introduced to further ameliorate patients’ outcome. As for open infrarenal aortic aneurysm repair no multimodal approaches exist to reduce morbidity and mortality. The aim of our study was therefore to establish and to evaluate a fast track program for open infrarenal aneurysm repair in a prospective, randomized and controlled trial. Methods: Patients with infrarenal aortic aneurysm and an indication for elective open repair have been randomly assigned either to a traditional or a fast track patient management. Main differences between the two groups consist in preoperative bowel preparation (none vs. 3l cleaning solution) and perioperative analgesia (epidural anesthesia in the fast track group). Study endpoints analyzed include morbidity and mortality, necessity of postoperative ventilation, length of ICU stay, time to complete food intake and patient satisfaction. Results: To date 45 patients have been enrolled — 23 for the traditional, 22 for the fast track program. Both groups are comparable in terms of age, aneurysm diameter and ASA Score. In both groups the transperitoneal as well as the retroperitoneal approach to aneurysm exclusion is performed. In the traditional group the need for postoperative ventilation is significantly increased (39 % vs. 9 %, p < 0.05) The length of ICU stay is decreased in the fast track group: 43 h vs. 21 h (median). In the fast track group parenteral nutrition could be finished earlier (2.5 vs. 5 days, median), complete oral food intake was achieved earlier (5.5 vs. 7 days, median). The median time to discharge from hospital was 10 days in the fast track, 11 days in the traditional group. Mortality in both groups was 0%, morbidity in fast track group decreased to 13.6 % vs. 39 % in the traditional group. Conclusion: For open infrarenal aneurysm repair the feasibility and safety of a fast track program could be demonstrated. In terms of postoperative ventilation a significant advantage for the fast track regimen could be detected. As for the length of ICU treatment, time to complete oral food intake and morbidity the fast track program appears to be superior to the traditional regimen.