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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

lingua: Inglese

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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