Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Patient Population
High-risk abdominal surgery.

LiDCO Monitor

Trial Design
The acute high-risk abdominal (AHA) study was a controlled single-centre intervention study in an unselected consecutive cohort undergoing AHA surgery.

Outcome Impact
The 30-day mortality rate was 15.5 per cent in the intervention cohort compared with 21.8 per cent in the control cohort (P=0.005; relative risk reduction 29 per cent). The 180-day mortality was 22.2 per cent in the intervention cohort compared with 29.5 per cent in the control cohort (P=0.004).

The primary aim of this study was to evaluate the effect of a standardized multidisciplinary perioperative protocol on 30-day mortality for patients undergoing AHA surgery.

1200 patients were included in this study with 600 in each cohort.

Primary outcomes were improved in the ERAS group. LOS was significantly shorter in the ERA patients compared to the non-ERAS patients (6.2 vs 9.6 days; P=0.024). Severity of complications was lower in the ERAS group. No mortality was reported within the ERAS group, whereas 3 patients died within the non-ERAS group (P=0.044). The mean cost of surgical-related hospital stay was significantly decreased in the ERAS group ($21,674 vs $30,380; P=0.029). Readmission rates were significantly lower in the ERAS group (11.5 vs 21.4%; P=0.029).

An ERAS program can be instituted by an individual surgeon with the benefits of decreased LOS, cost, and mortality.