Vascular Surgery and ERAS

Abstract

Enhanced recovery after surgery (ERAS) pathways have been beneficial for many surgical specialties, but these coordinated care pathways have yet to be developed for patients undergoing vascular operations. Vascular surgery patients present specific challenges due to their advanced age, frailty, and multiple comorbidities as well as the highly invasive operations that are sometimes required. This combination of factors results in complex management strategies, increased utilization of healthcare resources, and high rates of postoperative complications leading to prolonged hospitalizations, chronic pain, rehabilitation needs, and frequent hospital readmissions. ERAS, with its aim of delivering high-quality perioperative care and accelerating recovery, appears well-suited to address the needs of this demanding population. Most of the available evidence for ERAS for vascular surgery is derived from studies of fast-track pathways applied to open aortic surgery with no studies of ERAS (or ERAS-like pathways) in cerebrovascular, lower extremity, or endovascular surgery. Results from the open aortic surgery studies have suggested that the use of ERAS pathways in vascular surgery patients may decrease postoperative complications and hospital length of stay with faster times to extubation, resumption of diet, ambulation, and freedom from narcotics. It is expected that in the coming years, further evidence will become available, and more ERAS pathways will emerge for different types of vascular operations.