title: Fast track management reduces the systemic inflammatory response and organ failure following elective infrarenal aortic aneurysm repair.
abstract: OBJECTIVE
  Systemic inflammatory response syndrome (SIRS) is common after abdominal aortic aneurysm (AAA) repair. The aim of this study was to analyze the impact of a multimodal fast track (FT) regimen on incidence rates of SIRS after elective infrarenal AAA repair.
  
  
  METHODS
  Post hoc analysis of a randomized controlled trial including 99 patients after either traditional (TC) or FT care. Basic FT elements were no bowel preparation, reduced preoperative fasting, patient controlled epidural analgesia, enhanced postoperative feeding and mobilization. The presence of SIRS, organ failure and mortality, length of stay (LOS) on intensive care unit (ICU) were analyzed during the postoperative course.
  
  
  RESULTS
  The incidence of SIRS in the FT treatment arm was significantly lower as compared to TC: 28% vs. 50%, P = 0.04. The rate of any organ failure (AOF) and multiple organ failure (MOF) was lower in the FT group: AOF: 16% vs. 36%, P = 0.039; MOF: 2% vs. 12%; P = 0.112. LOS on ICU showed a slight advantage for FT care: 20 hours vs. 32 hours (P = 0.183).
  
  
  CONCLUSIONS
  An optimized patient care program in elective open AAA repair significantly decreases the postoperative incidence of SIRS as well as rates of organ failure.
authors.affiliation: Department of Thoracic and Vascular Surgery, University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany. bernd.muehling@uniklinik-ulm.de
authors.forename: Bernd M
authors.initials: BM
authors.lastname: Muehling
authors.forename: Lutz
authors.initials: L
authors.lastname: Ortlieb
authors.forename: Alexander
authors.initials: A
authors.lastname: Oberhuber
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Orend
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods; D016058:Analgesia, Patient-Controlled; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004434:Early Ambulation; D004435:Eating; D017558:Elective Surgical Procedures; D005215:Fasting; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality