title: Fast-track in abdominal aortic surgery: experience in over 1,000 patients.
abstract: BACKGROUND
  Fast-track recovery programs have led to reduced patient morbidity and mortality after surgery. Minimally invasive surgery and anesthesia, with programs of early postoperative recovery are the main aspects of fast-track recovery programs. The optimization of pain control, early mobilization, and oral feeding allows for a rapid functional rehabilitation, which leads to minor morbidity and early discharge from the hospital to home.
  
  
  METHODS
  We enrolled all nonemergent patients treated for elective abdominal aortic surgery for an aneurysm or obstructive disease from April 2000 to June 2014. The fast-track protocol was applied to all these patients. A transperitoneal aortic approach was used through a left subcostal incision and was complemented with epidural anesthesia-analgesia and a protocol of early rehabilitation.
  
  
  RESULTS
  A total of 1,014 patients were treated for elective aortic surgery. For 980 patients (96.6%), clear liquids followed by a semisolid diet were tolerated starting on the afternoon of the day of intervention (day 0). Nine hundred eighty-seven patients (97.3%) began early ambulation on day 0, and for 81.2% of the population, regular colonic function returned within the second postoperative day. Seventeen deaths (1.7%) occurred. Nine hundred ten patients (89.7%) had no complications. The median hospital length of stay was 3 days for the entire series, and 80.4% of patients (n = 815) were discharged to their homes between the second and fifth days after surgery.
  
  
  CONCLUSIONS
  The fast-track program can be efficiently and safely applied to aortic surgery and that this program improves surgical outcomes, allows for earlier discharge, and reduces costs.
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Brustia
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Novara, Novara, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Renghi
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy. Electronic address: aronicim@gmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Aronici
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Novara, Novara, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Gramaglia
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Porta
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Musiani
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Martelli
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Casella
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Mrancesco Letizia
authors.initials: ML
authors.lastname: De Simeis
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Coppi
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Settembrini
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mottini
authors.affiliation: Department of Vascular Surgery, University Hospital of Novara, Novara, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Cassatella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality