“…All but one study 18 considered elective AAA surgery exclusively. Six studies 16,19,20,22,24,25 reported including infrarenal AAAs exclusively.Figure 1.Preferred reporting items for systematic reviews and meta-analyses diagram.…”
Section: Resultsmentioning
confidence: 99%
“…This resulted in 10 full-text publications, with a combined population of 1569 patients across four countries dating 2003-2021. [16][17][18][19][20][21][22][23][24][25] Two RCTs were found, 19,20 evaluating "fast-track" vs traditional patient care in open AAA surgery. These trials utilised the same population of 101 patients, and despite RCT methodology were low-quality with limitations in reliability and validity when evaluated by LEGEND criteria.…”
Section: Resultsmentioning
confidence: 99%
“…All but one study 18 considered elective AAA surgery exclusively. Six studies 16,19,20,22,24,25 reported including infrarenal AAAs exclusively.…”
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.
“…All but one study 18 considered elective AAA surgery exclusively. Six studies 16,19,20,22,24,25 reported including infrarenal AAAs exclusively.Figure 1.Preferred reporting items for systematic reviews and meta-analyses diagram.…”
Section: Resultsmentioning
confidence: 99%
“…This resulted in 10 full-text publications, with a combined population of 1569 patients across four countries dating 2003-2021. [16][17][18][19][20][21][22][23][24][25] Two RCTs were found, 19,20 evaluating "fast-track" vs traditional patient care in open AAA surgery. These trials utilised the same population of 101 patients, and despite RCT methodology were low-quality with limitations in reliability and validity when evaluated by LEGEND criteria.…”
Section: Resultsmentioning
confidence: 99%
“…All but one study 18 considered elective AAA surgery exclusively. Six studies 16,19,20,22,24,25 reported including infrarenal AAAs exclusively.…”
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.
“…Finally, the biggest limitation is that we did not investigate if this protocol can reduce complications and improve outcomes. A randomized controlled trial for this should be desirable [22].…”
Purpose: Intra-operative hypotension (IOH) is associated with a poor post-operative outcome. Consequently, it seems important to reduce the incidence of hypotensive events during anesthesia. The Hemosphere TM (Edwards Lifescience Co., Irwin, CA, USA) platform provides the Hypotension Prediction Index (HPI), a predictive marker for a drop in blood pressure within a few minutes. We report the results of one year of application of a simple HPIalgorithm aiming at reducing the incidence of IOH in open abdominal aortic repair (oAAr), a type of surgery during which hemodynamic stability is notably challenging. Methods: We report the incidence of IOH in 40 patients submitted to oAAr in our tertiary Humanitas Research Hospital in Milan (Italy). The duration and severity of IOH was calculated by mean the Time Weighted Average (TWA) as follows: TWA = [(65-MAP) × time in hypotension]/Duration of monitoring. We compared TWA in our cohort with our preceding case series monitored by FloTrac/EV1000 TM . Results: TWA, expressed as median and IQR range, was 0.3 (0.00÷0.73) mmHg while the duration of an hypotensive event was 2.0 (1.3÷3.1) minutes. The intra-operative time spent in hypotension was 3.54% and the number of hypotensive episodes for each patient was 1.5 (1÷3). TWA resulted lower than the comparison ones and lower than the value observed in the study performed by Wijnberge (TWA = 0.44 mmHg × minute) conducted in major surgery.
Conclusions:In open abdominal aortic surgery, the application of a simple algorithm based on HPI, seems to be able to reduce the incidence, severity and duration of arterial hypotension.
“…According to an institutional fast-track protocol, all the patients routinely received a hypercaloric drink in the morning, at least two hours before their admission to the operating theatre. When the patient returned to the ward after the operation, usually in the evening (at least 4 h after awakening), he received oral fluids (usually a cup of tea) and assisted early mobilization (sitting on an armchair, then later standing up and having a brief walk) [ 11 ].…”
Background: The Cardiac Power Index (CPI) measures the rate of energy output generated by the heart and correlates this with in-hospital mortality due to cardiogenic shock. In open aortic surgery, both aortic clamping and unclamping expose the heart to abrupt variations of the left ventricle afterload, preload, and contractility, with possible hemodynamic impairment. We investigated how aortic-cross clamping (Ao-XC) and unclamping (Ao-UC) procedures affect the CPI during open aortic surgery. Methods: We retrospectively analyzed our surgical database of 67 patients submitted to open surgical aortic repair at Humanitas Research Hospital, Milan. Patients were monitored by an EV1000-FloTrac SystemTM (Edwards Lifescience, Irvine, CA, USA) beyond the standard intra-operative hemodynamic monitoring. The primary outcome was the variation of basal CPI after aortic clamping and unclamping. Secondary outcomes were variations of the cardiac index (CI), mean arterial pressure (MAP), heart rate, and lactate during aortic clamping and after unclamping. The CPI was computed as: (CI × MAP)/451. Results: The CPI changed significantly after aortic unclamping. CPI: basal = 0.39 ± 0.1 W/m2, after Ao-XC = 0.39 ± 0.1 W/m2, and after Ao-UC = 0.44 ± 0.2 W/m2, p < 0.05. The CI changed during both cross-clamping and unclamping (p < 0.0001), whilst the MAP and heart rate did not during any phase of the surgery. Five subjects (8.3%) needed inotropic support after cross-clamping. Their basal CPI was lower than the general population: 0.31 ± 0.11 W/m2 vs. 0.39 ± 0.1 W/m2. Conclusions: The CPI describes the adaptation of the cardiac function to the changes in preload, contractility, and afterload occurring during aortic cross-clamping and unclamping. It may be used to explore the cardiac performance in real-time and predict cardiac impairment in the intraoperative period in a minimally invasive way, similar to ventriculo-arterial coupling parameters.
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