Endovascular versus "fast-track" abdominal aortic aneurysm repair

Christopher Joseph Abularrage, Michael J. Sheridan, Dipankar Mukherjee

Research output: Contribution to journalArticle

Abstract

Recent studies have shown that endovascular abdominal aortic aneurysm repair (EVAR) has decreased costs, as well as decreased intensive care unit and total hospital length of stays when compared to abdominal aortic aneurysm (AAA) repair using a retroperitoneal exposure. The authors hypothesized that the fast-track AAA repair, which combines a retroperitoneal exposure with a patient care pathway that includes a gastric promotility agent and patient-controlled analgesia, would have no differences when compared to EVAR. Records of 58 patients who underwent AAA repair between April 14, 2000, and July 12, 2002, were reviewed retrospectively. Demographic information, length of stay, intraoperative and postoperative complications, mortality, and costs were evaluated. Fifty-eight AAA repairs were performed with the EVAR (n = 28) and fast-track (n = 30) techniques. The EVAR group was slightly older (72 vs 68 years, p = 0.04), had slightly smaller average aneurysm size (5.5 ±0.13 vs 6.1 ±0.17 cm, p = 0.008), and had more patients designated American Society of Anesthesia class 4 (p <0.0001). Both groups were predominantly male. Otherwise there were no statistically significant differences in risk factors. Patients who underwent fast-track repair tended to have a longer operation (216 ±7.4 vs 158 ±6.8 minutes, p <0.0001), with a greater volume of blood (1.8 ±0.29 vs 0.32 ±0.24 units, p = 0.0005), colloid (565 ±89 vs 32 ±22 cc, p <0.0001), and crystalloid transfusions (4,625 ±252 vs 2,627 ±170 cc, p <0.0001). There were no statistically significant differences in the number of intraoperative or postoperative complications between the 2 groups. EVAR patients resumed a regular diet earlier (0.21 ±0.08 vs 1.8 ±0.11 days, p <0.0001). Intensive care unit stay was shorter for EVAR (0.50 ±0.10 vs 0.87 ±0.10 days, p = 0.01), but floor (2.1 ±0.23 vs 2.6 ±0.21 days, p = 0.17), and total hospital lengths of stay (2.8 ±0.32 vs 3.4 ±0.18 days, p = 0.07) were similar between the 2 groups. Total hospital cost was lower in the fast-track ($10,205 ±$736 vs $20,640 ±$1,206, p <0.0001) leading to greater overall hospital earnings ($6,141 ±$1, 280 vs $107 ±$1,940, p = 0.01). Fast-track AAA repair is a viable alternative for the treatment of abdominal aortic aneurysms. Compared to endovascular repair, the fast-track method had increased transfusions of blood and intravenous fluids and increased operating room times, but equivalent lengths of floor and total hospital stay and increased total hospital earnings.

Original languageEnglish (US)
Pages (from-to)229-236
Number of pages8
JournalVascular and Endovascular Surgery
Volume39
Issue number3
DOIs
StatePublished - May 2005
Externally publishedYes

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Abdominal Aortic Aneurysm
Length of Stay
Intraoperative Complications
Intensive Care Units
Gastrointestinal Agents
Costs and Cost Analysis
Patient-Controlled Analgesia
Hospital Costs
Colloids
Operating Rooms
Blood Volume
Blood Transfusion
Aneurysm
Patient Care
Anesthesia
Demography
Diet

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Endovascular versus "fast-track" abdominal aortic aneurysm repair. / Abularrage, Christopher Joseph; Sheridan, Michael J.; Mukherjee, Dipankar.

In: Vascular and Endovascular Surgery, Vol. 39, No. 3, 05.2005, p. 229-236.

Research output: Contribution to journalArticle

Abularrage, Christopher Joseph ; Sheridan, Michael J. ; Mukherjee, Dipankar. / Endovascular versus "fast-track" abdominal aortic aneurysm repair. In: Vascular and Endovascular Surgery. 2005 ; Vol. 39, No. 3. pp. 229-236.
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