Fast Track Management in Elective Open Infrarenal Aortic Aneurysm Repair

Fast track programs have been introduced in many surgical fields to minimize postoperative morbidity and mortality. Morbidity after elective open infrarenal aneurysm repair is as high as 30%, mortality ranges up to 10%. In terms of open infrarenal aneurysm repair no randomized controlled trials exist to introduce and evaluate such patient care programs.

Prospective randomization of patients admitted with infrarenal aortic aneurysm who undergo elective open repair in a "traditional" and "fast track" treatment arm. Main differences consist in preoperative bowel washout (none vs. 3L cleaning solution) and analgesia (patient controlled analgesia vs. patient controlled epidural analgesia: PCA vs. PCEA). Study endpoints are morbidity and mortality, need for postoperative mechanical ventilation and length of stay (LOS) on intensive care unit (ICU).

• Procedure: Fast track patient management
  no bowel washout, patient controlled epidural anesthesia, early enteral feeding
• Procedure: Traditional management
  preoperative bowel washout, patient controlled analgesia, delayed start of enteral feeding

• Active Comparator: A
  Traditional management including preoperative bowel washout, patient controlled analgesia (PCA), delayed start of enteral feeding
  Intervention: Procedure: Traditional management
• Experimental: B
  Fast track management including no bowel washout, patient controlled epidural anesthesia, early enteral feeding
  Intervention: Procedure: Fast track patient management

Inclusion Criteria:

• infrarenal aortic aneurysm
• given written informed consent

Exclusion Criteria:

• contraindication for epidural anesthesia
• suprarenal clamping