Infrarenal aortic surgery with a 3-day hospital stay: A report on success with a clinical pathway

Purpose: This paper reports on an experience with a clinical pathway for elective infrarenal aortic surgery (AS) that targeted hospital discharge on postoperative day (POD) 3. The pathway incorporated early feeding, early ambulation, and selective use of the intensive care unit (ICU). Methods: A review of 50 consecutive hospital discharges after AS (aneurysm repair and aortofemoral bypass grafting) by a single surgeon performed from April 1996 through Tune 1998 with this clinical pathway is reported. The data collected included morbidity rate, mortality rate, length of stay (LOS), and number of hospital readrnissions. Results: The average LOS for all patients was 3.0 days. Only six patients (12%) were admitted to the ICU. Discharge on POD 3 was achieved in 80% of the group (40 of 50), and increasing experience improved compliance, with 92% of the most recent 25 patients (23 of 25) being discharged by POD 3. Eleven of these 25 patients (44%) were discharged on POD 2. No patient was readmitted to the hospital within a 30-day period after discharge. There was no mortality after AS during this period. Conclusion: Factors that limit the discharge of patients recovering from AS include the ability to ambulate independently and to tolerate a diet. Ambulation and feeding on POD 1 were well tolerated by most patients, which shortened the period of hospitalization. Admission to the ICU was infrequently required when a monitored surgical step-down unit was available. Discharge by POD 3 for AS has been proven to be routinely achievable, safe, and well accepted by patients and to reduce the cost of hospitalization.