Enhanced recovery after surgery program in elective infrarenal abdominal aortic aneurysm repair

BACKGROUND: The aim of this paper was to investigate the differences in length of hospital stay (LOS) between patients receiving an enhanced recovery after surgery (ERAS) approach and patients receiving conventional perioperative care in elective infrarenal abdominal aortic aneurysm (AAA) repair. Secondary endpoints were the difference in postoperative pulmonary, renal, cardiovascular and gastrointestinal complications, unplanned intensive care unit admission, surgical reintervention and in-hospital mortality between groups. METHODS: In this retrospective observational study, data of all patients undergoing open infrarenal AAA repair between June 2009 and December 2014 were recorded. After excluding the first month, we propensity matched 2:1 patients operated on before and after the introduction of an ERAS program (started in September 2012). RESULTS: A total of 1034 elective open infrarenal AAA repairs were performed during the study period. Six-hundred and sixty-three patients who underwent surgery between June 2009-September 2012 received standard perioperative care and were propensity matched with 371 patients who underwent surgery between October 2012-December 2014 after implementing ERAS approach in September 2012 in 13 patients. A statistically significant reduction in LOS (6.0 [5.5-6.5] vs. 5.5 [5.4-6.5] days; P=0.021) and pulmonary complications (9.6% vs. 4.7%; P=0.014) in the ERAS group were recorded. Other postoperative complications, need for unplanned intensive care unit admission, need for surgical reintervention and in-hospital mortality were similar between groups. CONCLUSIONS: An ERAS program is effective in reducing LOS and pulmonary complications after elective infrarenal AAA repair.