Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients.
BACKGROUND
Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery.


OBJECTIVE
To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients.


METHODS
Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity.


RESULTS
The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01).


CONCLUSIONS
The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.
Aguilar-Nascimento
José Eduardo de
JE
Department of Surgery, Universidade Federal de Mato Grosso (UFMT), Cuiabá, MT, Brazil. aguilar@terra.com.br
Salomão
Alberto Bicudo
AB
Caporossi
Cervantes
C
Diniz
Breno Nadaf
BN
D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005215:Fasting; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D019990:Perioperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome