title: The effect of an Enhanced Recovery Program in elective retroperitoneal abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Enhanced Recovery Programs (ERPs) have been introduced to accelerate postoperative recovery and are mainly focused on decreasing the surgical stress response. Limited data are available regarding the implementation of ERPs in patients who undergo abdominal aortic aneurysm (AAA) repair using the retroperitoneal approach. The aims of this study were: (1) to evaluate the implementation of an ERP in patients who underwent elective retroperitoneal AAA repair; and (2) to define independent predictors of prolonged hospital length of stay (LOS) in these patients.
  
  
  METHODS
  This was a retrospective cohort study on 221 patients who underwent elective AAA repair via a retroperitoneal approach from 2005 through 2013 at an Italian university hospital. Patients who received surgery from 2008 through 2013 and enrolled in an ERP (n = 130) were compared with those who received surgery from 2005 through 2007 and managed with traditional perioperative care (n = 91).
  
  
  RESULTS
  Patient characteristics were comparable between groups. Intensive care unit admissions were prevalent among patients who received traditional care vs patients in the ERP (P < .01). ERP patients had fewer major (P < .01) and minor (P = .019) complications, and mortality was similar between groups. Complete functional recovery was achieved earlier in ERP patients vs controls (P < .01). Patients in the ERP group left the hospital earlier than controls (P < .01). No readmission ≤30 days were reported in the ERP group. Age ≥65 years and being in a conventional care protocol were found to be independent predictors of prolonged hospital LOS.
  
  
  CONCLUSIONS
  The implementation of an ERP after elective AAA repair using a retroperitoneal approach reduced postoperative intensive care unit admission, accelerated functional recovery, and decreased morbidity and LOS with no readmission ≤30 days. Age ≥65 years and conventional perioperative care were the only independent predictors of prolonged LOS.
authors.affiliation: Department of Surgery, Unit of Clinica Chirurgica, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
authors.forename: Carlo V
authors.initials: CV
authors.lastname: Feo
authors.affiliation: Department of Surgery, Unit of Clinica Chirurgica, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy. Electronic address: mattia.portinari@unife.it.
authors.forename: Mattia
authors.initials: M
authors.lastname: Portinari
authors.affiliation: Department of Surgery, Unit of Vascular Surgery, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
authors.forename: Elpiniki
authors.initials: E
authors.lastname: Tsolaki
authors.affiliation: Department of Surgery, Unit of Clinica Chirurgica, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Romagnoni
authors.affiliation: Department of Emergency Medicine, Unit of Anesthesiology and Intensive Care, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Verri
authors.affiliation: Department of Emergency Medicine, Unit of Anesthesiology and Intensive Care, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Camerani
authors.affiliation: Department of Emergency Medicine, Unit of Anesthesiology and Intensive Care, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Volta
authors.affiliation: Department of Surgery, Unit of Vascular Surgery, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mascoli
mesh_terms: D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D015397:Program Evaluation; D016016:Proportional Hazards Models; 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