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The Journal of Cardiovascular Surgery 2003 October;44(5):629-35

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Mininvasive abdominal aortic surgery. Early recovery and reduced hospitalization after multidisciplinary approach

Brustia P., Renghi A., Gramaglia L., Porta C., Cassatella R., De Angelis R., Tiboldo F.

Departments of Vascular Surgery and of Anesthesiology, Ospedale degli Infermi, Biella, Italy


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Aim. Clin­ical expe­ri­ence in gas­troin­tes­tinal sur­gery dem­on­strated ­that a mul­ti­modal ­approach can ­improve the out­come and ­reduce the ­length of hos­pital ­stay. In ­this ­paper we inves­ti­gate the ­impact of a mul­ti­modal clin­ical pro­gram, ­based on min­in­va­sive sur­gery, epi­dural anes­thesia and ­early ­feeding and mobil­iza­tion, on post­op­er­a­tive mor­bidity and hos­pi­tal­iza­tion ­after abdom­inal ­aortic sur­gery.
­Methods. A 2-­armed ­study was ­designed. All ­patients under­going abdom­inal ­aortic sur­gery ­between May 2000 and ­April 2001 ­were ­enrolled in a mul­ti­dis­ci­pli­nary clin­ical pro­gram ­including tho­racic epi­dural anes­thesia and anal­gesia, ­left sub-­costal min­i­lap­a­rotomy ­without evis­cer­a­tion, encour­age­ment to ­feed and mobi­lize ­soon ­after sur­gery (Mul­ti­dis­ci­pli­nary ­group: n=82). For com­par­ison pur­poses, a ret­ro­spec­tive anal­ysis was con­ducted ­using the ­data of all ­patients oper­ated on ­between Jan­uary and ­December 1997, ­receiving stan­dard anes­thesia ­care and a stan­dard sur­gical and ­nursing pro­gram (Stan­dard ­group: n=64).
­Results. In the Mul­ti­dis­ci­pli­nary ­group we ­observed sig­nif­i­cantly ­better ­pain ­relief (p<0.01), ear­lier res­to­ra­tion of ambu­la­tion (p<0.01), ear­lier ­feeding (p<0.01) and pas­sage of ­stools (p<0.01). The inci­dence of com­pli­ca­tions was sig­nif­i­cantly ­lower in the Mul­ti­dis­ci­pli­nary ­group: pul­mo­nary (0% vs 14.1%), car­diac (2.4% vs 9.4% ) and gas­troin­tes­tinal (0% vs 10.9%). ­None of the ­patients in the Mul­ti­dis­ci­pli­nary ­group ­required admis­sion to Inten­sive ­Care. ­Median post­op­er­a­tive hos­pi­tal­iza­tion was 3 ­days in the Mul­ti­dis­ci­pli­nary ­group com­pared to 9 ­days in the Stan­dard ­group (p<0.01).
Con­clu­sion. ­These ­results sug­gest ­that a mul­ti­dis­ci­pli­nary inter­ven­tion ­with ­rewiev of the tra­di­tional sur­gical ­care pro­gram ­would ­enhance ­recovery, ­decrease mor­bidity and hos­pi­tal­iza­tion ­after abdom­inal ­aortic sur­gery.

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