Mininvasive abdominal aortic surgery. Early recovery and reduced hospitalization after multidisciplinary approach.
OBJECTIVE
Clinical experience in gastrointestinal surgery demonstrated that a multimodal approach can improve the outcome and reduce the length of hospital stay. In this paper we investigate the impact of a multimodal clinical program, based on mininvasive surgery, epidural anesthesia and early feeding and mobilization, on postoperative morbidity and hospitalization after abdominal aortic surgery.


METHODS
A 2-armed study was designed. All patients undergoing abdominal aortic surgery between May 2000 and April 2001 were enrolled in a multidisciplinary clinical program including thoracic epidural anesthesia and analgesia, left sub-costal minilaparotomy without evisceration, encouragement to feed and mobilize soon after surgery (Multidisciplinary group: n=82). For comparison purposes, a retrospective analysis was conducted using the data of all patients operated on between January and December 1997, receiving standard anesthesia care and a standard surgical and nursing program (Standard group: n=64).


RESULTS
In the Multidisciplinary group we observed significantly better pain relief (p<0.01), earlier restoration of ambulation (p<0.01), earlier feeding (p<0.01) and passage of stools (p<0.01). The incidence of complications was significantly lower in the Multidisciplinary group: pulmonary (0% vs 14.1%), cardiac (2.4% vs 9.4% ) and gastrointestinal (0% vs 10.9%). None of the patients in the Multidisciplinary group required admission to Intensive Care. Median postoperative hospitalization was 3 days in the Multidisciplinary group compared to 9 days in the Standard group (p<0.01).


CONCLUSIONS
These results suggest that a multidisciplinary intervention with review of the traditional surgical care program would enhance recovery, decrease morbidity and hospitalization after abdominal aortic surgery.
Brustia
P
P
Department of Vascular Surgery, Ospedale degli Infermi, Biella, Italy. brustiapiero@tiscali.it
Renghi
A
A
Gramaglia
L
L
Porta
C
C
Cassatella
R
R
De Angelis
R
R
Tiboldo
F
F
D000368:Aged; D000767:Anesthesia, Epidural; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010348:Patient Care Team; D010351:Patient Discharge / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data