[Fast-track rehabilitation after open aorto-iliac vascular procedures].
BACKGROUND
Fast-track rehabilitation programs have resulted in a decrease in mortality and morbidity after major surgical procedures, e. g., in colorectal surgery. It is not known whether fast-track rehabilitation can safely be applied in major vascular surgery.


METHODS
35 patients (mainly ASA III) who underwent open aorto-iliac reconstruction (21 for abdominal aneurysm, 14 for aorto iliac occlusive disease) between May 2005 and June 2006 were treated with a fast-track protocol including PDA, early postoperative oral fluid and food supply, early postoperative mobilisation, all starting on the day of operation. The average daily oral fluid amount, duration of mobilisation, step of oral nutrition, day of first defecation, PONV, pain levels while resting, under effort and mobilisation, and fatigue were monitored.


RESULTS
The 30-day mortality was 0%, overall morbidity was 14.8% with 9% pulmonary, 2.9% cardiac and 2.9% renal complications. Mobility was safely achieved. The oral fluid consumption was 329 mL on the day of operation and 1160 mL on the second day after operation. 33 patients (94%) achieved total oral nutrition on day four after operation. The average pain level in all categories and the fatigue were below 4 on the VAS.


CONCLUSIONS
Fast-track rehabilitation can safely be applied to patients undergoing conventional aorto-iliac reconstruction. Early onset of oral nutrition and mobilisation influence the fatigue in a positive way. Thoracal PDA leads to acceptable pain levels.
Löhr
G
G
Vaskuläre und Endovaskuläre Chirurgie am SRH Klinikum Karlsbad-Langensteinbach gGmbH. Guido.loehr@vivantes.de
Keller
H
H
Kütscher
J
J
Huber
R
R
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D004434:Early Ambulation; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000534:rehabilitation*; D016019:Survival Analysis