RS21 - Impact of ERAS Protocol Adherence on Outcomes After Elective Open Abdominal Aortic Aneurysm Repair and Core Items Identification.

Objectives: Enhanced Recovery After Surgery (ERAS) protocols have been introduced in vascular surgery over the past decade and their implementation requires a substantial change in established clinical routines. In other surgical specialties, higher adherence to ERAS protocols (>70%) has been associated with significantly improved clinical outcomes compared with lower adherence. Nevertheless, the individual impact of specific perioperative components, and the relevance of overall protocol adherence in relation to clinical outcomes, remains unclear in the field of vascular surgery.
The aim of this study was to evaluate protocol adherence and to assess the influence of individual ERAS components after six years of protocol implementation in patients undergoing elective open abdominal aortic aneurysm (AAA) repair.

Methods: All patients undergoing elective open AAA repair managed with ERAS protocol between January 2019 and December 2024 were included. Adherence to seven perioperative ERAS items was assessed, and patients were stratified into two groups according to protocol adherence ( < 70% vs ≥70%). Groups were compared in terms of demographics, comorbidities, early outcomes (time to discharge [TTD], mortality, complications, and readmissions), and late outcomes (overall survival, reintervention-free survival, and complication-free survival). Linear regression analysis was used to evaluate the impact of individual ERAS components on TTD.

Results: A total of 206 patients were included; 112 (54.4%) achieved ERAS adherence ≥70%. Patients with high adherence were predominantly male (91.1%) with a mean age of 69.3 years, with no significant differences compared with the low-adherence group in terms of age, sex, or baseline comorbidities. TTD was significantly shorter in the ≥70% adherence group compared with the < 70% group [5.6 (SD 1.38) vs 8.6 days (SD 4.69), p < 0.001], and perioperative complications were significantly reduced (1.8% vs 19.1%, p < 0.001). No deaths or hospital readmissions occurred within 30 days in either group. Follow-up was completed in 99.5% of patients, with a mean duration of 44.4 months. Four-year overall survival was significantly higher in patients with ERAS adherence ≥70% compared with those with lower adherence (95% vs 89%, p = 0.029). Linear regression analysis identified avoidance of preoperative fasting, avoidance of nasogastric tube placement, and early urinary catheter removal as independent predictors of shorter TTD.

Conclusions: High ERAS protocol adherence (>70%) was associated with a significant reduction in hospital stay, perioperative complications, and mortality, as well as with improved long-term survival. Multivariate analysis confirmed the beneficial effect of specific ERAS components, particularly avoidance of preoperative fasting and early removal of invasive devices.