Fast-track in Abdominal Aortic Surgery: Experience in Over 1,000 Patients

Brustia, Piero; Renghi, Alessandra; Aronici, Michele; Gramaglia, Luca; Porta, Carla; Musiani, A; Martelli, Massimiliano; Casella, Francesco; Simeis, Mrancesco Letizia De; Coppi, Giovanni; Settembrini, Alberto M.; Mottini, Francesca; R, Cassatella

doi:10.1016/j.avsg.2015.02.012

Cited by 28 publications

(15 citation statements)

References 28 publications

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“…[1][2][3][4][5] It can be particularly effective as part of a multi-modal analgesic approach. 6,7 However, because the standard approach to epidural catheter placement relies on indirect anatomic assessments (palpation, 'loss of resistance', surface measurements of depth), epidural catheters can be non-functional after surgery due to failure to correctly locate or maintain the catheter in the epidural space. The reported 'failure rates' for epidural catheters vary widely with published rates ranging from 12% to 40%, depending on experience, patient selection and the specific vertebral level chosen for catheter placement.…”

Section: Editorial Comment: What This Article Tells Usmentioning

confidence: 99%

Fluoroscopy‐assisted epidural catheter placement: an exploratory analysis of 303 pre‐operative epidurograms

Yeager

Bae

Parra

et al. 2015

Acta Anaesthesiol Scand

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Section: Editorial Comment: What This Article Tells Usmentioning

confidence: 99%

Fluoroscopy‐assisted epidural catheter placement: an exploratory analysis of 303 pre‐operative epidurograms

Yeager

Bae

Parra

et al. 2015

Acta Anaesthesiol Scand

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“…Several surgical specialties have introduced short-stay protocols for certain procedures with the goal of reducing complication rates, facilitating postoperative recovery, expediting hospital discharge, and reducing early readmissions 23,24. Yet few studies have investigated the financial implications of such treatment pathways in EVAR.…”

Section: Discussionmentioning

confidence: 99%

<p>Comparison of perioperative costs with fast-track vs standard endovascular aneurysm repair</p>

Krajcer¹,

Ramaiah²,

Henao³

et al. 2019

VHRM

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Background Perioperative health care utilization and costs in patients undergoing elective fast-track vs standard endovascular aneurysm repair (EVAR) remain unclear. Methods The fast-track EVAR group included patients treated with a 14 Fr stent graft, bilateral percutaneous access, no general anesthesia or intensive care monitoring, and next-day hospital discharge. The standard EVAR group was identified from Medicare administrative claims using a matching algorithm to adjust for imbalances in patient characteristics. Hospital outcomes included operating room time, intensive care monitoring, hospital stay, secondary interventions, and major adverse events (MAEs). Perioperative outcomes occurring from hospital discharge to 30 days postdischarge included MAE, secondary interventions, and unrelated readmissions. Results Among 1000 matched patients (250 fast-track; 750 standard), hospital outcomes favored the fast-track EVAR group, including shorter operating room time (2.30 vs 2.83 hrs, P <0.001), shorter hospital stay (1.16 vs 1.69 d, P <0.001), less need for intensive care monitoring (4.4% vs 48.0%, P <0.001), and lower secondary intervention rate (0% vs 2.4%, P =0.01). Postdischarge outcomes also favored fast-track EVAR with a lower rate of MAE (0% vs 7.2%, P <0.001) and all-cause readmission (1.6% vs 6.8%, P =0.001). The total cost to the health care system during the perioperative period was $26,730 with fast-track EVAR vs $30,730 with standard EVAR. Total perioperative health care costs were $4000 (95% CI: $3130–$4830) lower with fast-track EVAR vs standard EVAR, with $2980 in savings to hospitals and $1030 savings to health care payers. Conclusion A fast-track EVAR protocol using a 14 Fr stent graft resulted in shorter procedure time, lower intensive care utilization, faster discharge, lower incidence of MAE, lower readmission rates, and lower perioperative costs compared to standard EVAR.

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“…After initial implementation with colorectal surgeons in 2009 with minimally invasive teams, then expanded to the entire Division as a standard of practice for all patients undergoing colorectal surgery in 2011. Next, team members worked to diffuse to Gynecologic surgery [ 60 ], Breast [ 61 ], Urology [ 62 , 63 , 64 ], Endocrine, Hepatobiliary [ 65 , 66 ], Thoracic [ 67 , 68 ] and Vascular [ 69 , 70 ] within one campus of the institution, then continued to expand enterprise-wide knowledge within the same organization while also collaborating with teams at external organizations. The framework of spread was used, and results from network collaboratives shared [ 38 ].…”

Section: Methodsmentioning

confidence: 99%

Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic

Lovely

Larson

2021

Healthcare

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This work aims to describe the implementation and subsequent learnings from the first decade after the full implementation of enhanced recovery pathway for colorectal surgery at a single institution. This paper will describe the diffusion efforts and plans through the Define, Measure, Analyze, Improve, Control (DMAIC) process of ongoing quality improvement and through research efforts. The information applies to all readers that provide surgical care within their organization as the fundamental principles of enhanced recovery for surgery are applicable regardless of the setting.

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Fast-track in Abdominal Aortic Surgery: Experience in Over 1,000 Patients

Cited by 28 publications

References 28 publications

Fluoroscopy‐assisted epidural catheter placement: an exploratory analysis of 303 pre‐operative epidurograms

Fluoroscopy‐assisted epidural catheter placement: an exploratory analysis of 303 pre‐operative epidurograms

<p>Comparison of perioperative costs with fast-track vs standard endovascular aneurysm repair</p>

Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic

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