Fast track management reduces the systemic inflammatory response and organ failure following elective infrarenal aortic aneurysm repair

Objectives: Systemic inflammatory response syndrome (SIRS) is common after abdominal aortic aneurysm (AAA) repair. The aim of this study was to analyze the impact of a multimodal fast track (FT) regimen on incidence rates of SIRS after elective infrarenal AAA repair. Methods: Post hoc analysis of a randomized controlled trial including 99 patients after either traditional (TC) or FT care. Basic FT elements were no bowel preparation, reduced preoperative fasting, patient controlled epidural analgesia, enhanced postoperative feeding and mobilization. The presence of SIRS, organ failure and mortality, length of stay (LOS) on intensive care unit (ICU) were analyzed during the postoperative course. Results: The incidence of SIRS in the FT treatment arm was significantly lower as compared to TC: 28% vs. 50%, P=0.04. The rate of any organ failure (AOF) and multiple organ failure (MOF) was lower in the FT group: AOF: 16% vs. 36%, P=0.039; MOF: 2% vs. 12%; P=0.112. LOS on ICU showed a slight advantage for FT care: 20 hours vs. 32 hours (P=0.183). Conclusion: An optimized patient care program in elective open AAA repair significantly decreases the postoperative incidence of SIRS as well as rates of organ failure. (C) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.