A Systematic Review and Meta-Analysis of Enhanced Recovery for Open Abdominal Aortic Aneurysm Surgery

Abstract

Introduction: Open abdominal aortic aneurysm (AAA) surgery is associated with significant morbidity, mortality and high length of stay (LOS). Enhanced recovery is now commonplace and has been shown to decrease these in other non-vascular surgery settings. This systematic review and meta-analysis aimed to assess the benefits of enhanced recovery (ERAS) in aortic surgery. Method: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to undertake a systematic review via Ovid MEDLINE and Embase on 10.07.2021. The search terms were “aortic aneurysm” and “fast track” or “enhanced recovery”. Data was obtained on major complications, 30-day mortality and LOS. Results: 107 papers were identified and 10 papers included for meta-analysis. Complication rates were significantly reduced with ERAS compared to non-ERAS protocols (ERAS n = 709, non-ERAS n = 930) (odds ratio .38, .22 to .65: P = .0005). LOS was also significantly reduced with an ERAS protocol (ERAS n = 708, non-ERAS n = 956) with a mean reduction of 3 .18 days (−5.01 to −1.35 days) ( P = .0007: I2 = 97%). There was no significant difference however in 30-day mortality ( P = .92). Conclusion: This meta-analysis demonstrates significant benefits to an enhanced recovery programme in open AAA surgery. There is a need for a multi-centre randomized controlled trial to assess this further.

Benefits of Prehabilitation before Complex Aortic Surgery

“…This study showed encouraging results, with decreased postoperative assisted mechanical ventilation, fewer medical complications and faster recovery of gastrointestinal function. A recently published meta-analysis found benefits of ERAS in OAS in terms of hospital stay and postoperative complications, while no difference was found in 30-day mortality [78].…”

“…There is no available standardized ERAS protocol, but it is acknowledged that the positive influence on outcomes mainly depends on a combination of measures, with the isolated effect of individual elements being less important [79]. Integral components that should be considered and protocoled in all enhanced recovery pathways are fasting and carbohydrate loading, multimodal analgesia, prevention of postoperative nausea and vomiting, patient warming, anaesthetic protocols, postoperative fluid management, catheter/drain removal, early mobilization, and chest physiotherapy [20,78].…”

“…Only five studies were included, and the benefits of such programs were unclear. A meta-analysis published in 2022 pooled the results of only 10 studies (including two RCTs) with 709 patients, focusing on the impact of ERAS in the setting of OAS (Table 1) [78]. This highlights the tempered enthusiasm of the vascular community for ERAS in comparison to cardio-thoracic or general surgery.…”

Ambulatory anesthesia and discharge: an update around guidelines and trends

“…There is a growing body of evidence supporting the safety and efficacy of the enhanced recovery after surgery concept for various procedures. The most recent meta-analysis showing beneficial effects are in thyroid surgery [8 ▪ ], aortic aneurysm surgery [9 ▪ ] and pediatric surgery [10 ▪ ] all supporting its benefits in shortening hospital stay and improving patients’ satisfaction.…”

Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study

“…ERAS protocols must strike a delicate balance between delivering optimal care quality and reducing healthcare costs [10]. Consequently, the primary objectives include diminishing POC [11][12][13][14], reducing lengths of stay (LOS) [11][12][13][14][15][16][17], alleviating postoperative pain, and facilitating the swift return to normal physiological function. This approach has demonstrated its efficacy in enhancing the patients' quality of life [18] and satisfaction [19] during the perioperative period.…”