Fast Track Pathways : Early Ambulation after Open Aortic Surgery in Elderly Patients Is Not Only Safe but Recommendable

Introduction: Bed rest has always been an integral part of traditional perioperative care, but there is no evidence that it has any significant beneficial effect, especially in elderly patients. Conversely, the immediate recovery of ambulation improves outcomes after complex surgical procedures. We devised a multidisciplinary programme to achieve early ambulation after abdominal aortic surgery in elderly patients. Methods: We carried out a prospective study of patients older than 70 years who were scheduled for abdominal aortic surgery from January 2009 to December 2011. All patients were treated with minilaparotomy, light general anaesthesia and thoracic epidural anaesthesia. The postoperative programme consisted of continuous epidural analgesia and early mobilisation. Results: We enrolled 130 patients. The mean age was 76.1 years (95% CI=75.33-76.79). The patients began walking at a mean time of 175.2 (95% CI=145.3-205.2) min after the surgery. On the day of surgery, the mean ambulation time was 33.7 (95% CI=27.3-40.1) min, and the patients covered an average distance of 172.3 (95% CI=124.3-220.3). On the day after surgery the mean ambulation time was 157.7 (95% CI=146.8-168.6) min, and the patients covered an average distance of 1130.3 (95% CI=884.7-1375.9) metres. The perioperative mortality was 0.8% and the global morbidity was 12.3%. The patients had no pulmonary complications. We observed no side effects in connection with the early ambulation. The average time for the discharge to home was day 4 after surgery (range 2-24). Conclusion: In elderly patients, a multidisciplinary approach with mininvasive surgery, pain control and postoperative intensive rehabilitation allowed the rapid and safe recovery of ambulation after abdominal aortic surgery thereby contributing to an improved postoperative outcome.