Impact of Enhanced Recovery after Surgery Protocols on Outcomes after Open Abdominal Aortic Aneurysm Repair: A...

Elective open abdominal aortic aneurysm (AAA) repair remains associated with substantial postoperative morbidity and prolonged hospital length of stay (LOS). Enhanced recovery after surgery (ERAS) protocols have been increasingly implemented in vascular surgery; however, their impact on clinically relevant outcomes after open AAA repair has not been clearly quantified.

We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review and random-effects meta-analysis evaluating the impact of structured ERAS protocols in elective open AAA repair. Four comparative cohort studies involving 1,142 patients undergoing elective open AAA repair were included (ERAS, n = 556; conventional care, n = 586). Outcomes assessed were postoperative mortality, overall complications, and LOS. The protocol was prospectively registered in PROSPERO (CRD420251283076).

Compared with conventional care, ERAS protocols were associated with a significant reduction in postoperative complications (odds ratio 0.59, 95% confidence interval (CI) 0.42-0.86; P = 0.03) and shorter LOS (mean difference -1.32 days, 95% CI -1.89 to -0.75; P < 0.001). No significant difference in postoperative mortality was observed (odds ratio 0.87, 95% CI 0.33-2.30; P = 0.78). Between-study heterogeneity was low for mortality and complications and moderate for LOS.

ERAS protocols improve postoperative recovery after elective open AAA repair by reducing complications and LOS without compromising short-term safety. These findings support the integration of structured ERAS pathways into contemporary perioperative management for open AAA surgery.