Prospektive, randomisierte und kontrollierte Studie zur Evaluation eines »Fast track« Behandlungskonzeptes in der Aneurysmachirurgie

Abstract

Background: Fast track programs — multimodal therapy strategies — 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. Methods: In a prospective, randomized controlled pilot study a »traditional« and »fast track« treatment regimen in patients undergoing open infrarenal aneurysm repair was compared. Main differences between the two groups consisted in preoperative bowel washout (none vs. 3L cleaning solution) and analgesia (patient controlled analgesia vs. patient controlled epidural analgesia: PCA vs. PCEA). Study endpoints were morbidity and mortality, need for postoperative mechanical ventilation and length of stay (LOS) on intensive care unit (ICU). Results: 82 patients underwent randomization 79 were analyzed of per protocol. Both study groups were similar in terms of age, sex, ASA score and aneurysm diameter. In both groups trans- and retroperitoneal approach to the infrarenal aorta was performed. 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 h vs. 20 h. Gastrointestinal, renal, cardiac or infection associated complications were significantly lower in the fast track group: 16.2 % vs. 35.7 %; (p = 0.045); mortality in both groups was 0 %. Conclusion: We introduced and evaluated an optimized patient care program for patients undergoing open infrarenal aortic aneurysm repair. In terms of postoperative mechanical ventilation and morbidity we found a significant advantage for »fast track« patients. Using this optimized patient care management morbidity of open infrarenal aortic aneurysm repair could be significantly decreased as compared to a traditional treatment regimen.