{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T15:34:42Z","timestamp":1787326482866,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81870348"],"award-info":[{"award-number":["81870348"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82200543"],"award-info":[{"award-number":["82200543"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82101425"],"award-info":[{"award-number":["82101425"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["81870348"],"award-info":[{"award-number":["81870348"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"award":["82200543"],"award-info":[{"award-number":["82200543"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"award":["82101425"],"award-info":[{"award-number":["82101425"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004608","name":"Natural Science Foundation of Jiangsu Province, China","doi-asserted-by":"publisher","award":["BK20241719"],"award-info":[{"award-number":["BK20241719"]}],"id":[{"id":"10.13039\/501100004608","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Nanjing Municipal Special Fund Project for Health Science and Technology Development","award":["YKK24109"],"award-info":[{"award-number":["YKK24109"]}]},{"name":"New medical technology development project of Nanjing Drum Tower Hospital","award":["XJSFZLX202470"],"award-info":[{"award-number":["XJSFZLX202470"]}]},{"award":["XJSFZLX202470"],"award-info":[{"award-number":["XJSFZLX202470"]}],"id":[{"id":"https:\/\/ror.org\/026axqv54","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Jiangsu Province Innovation and Entrepreneurship Doctorate","award":["JSSCBS0281"],"award-info":[{"award-number":["JSSCBS0281"]}]},{"name":"Nanjing Drum Tower Hospital Youth Training Program of National Natural Science Foundation of China","award":["2023-JCYJ-QP-60"],"award-info":[{"award-number":["2023-JCYJ-QP-60"]}]},{"award":["2023-JCYJ-QP-60"],"award-info":[{"award-number":["2023-JCYJ-QP-60"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objective: Open surgical repair (OSR) remains an important treatment for abdominal aortic aneurysm (AAA), but its invasiveness contributes to substantial perioperative risk. Although Enhanced Recovery After Surgery (ERAS) pathways have improved outcomes across several surgical specialties, evidence supporting their use in open aortic surgery, particularly in Chinese clinical settings, remains limited. We, therefore, evaluated the association between adherence to a locally adapted ERAS pathway and early perioperative outcomes after elective OSR for AAA. Methods: This single-center retrospective cohort study included 182 patients who underwent elective OSR for AAA. Patients who received at least 70% of the 30 ERAS elements were assigned to the ERAS group (n = 93), whereas those who received less than 70% were assigned to the control group (n = 89). A total of 152 patients remained after 1:1 matching of the two groups using propensity score. Quantile regression and logistic regression models were used to evaluate the impact of the ERAS protocol on postoperative length of stay, 30-day mortality, ICU admission rate, hospital cost, major complications, and readmission. Results: After matching, baseline and aneurysm characteristics were generally comparable between groups. The ERAS group demonstrated a significantly reduced risk of major complications (OR = 0.33; 95% CI 0.16\u20130.71; p = 0.004) and postoperative nausea and vomiting (OR = 0.10; 95% CI 0.01\u20130.80; p = 0.030). The time to postoperative bowel movement was 1 day earlier in the ERAS group (p &lt; 0.001). The incidence of postoperative cardiac complications was significantly lower in the ERAS group (2.6% vs. 11.8%; p = 0.028). Pulmonary complications were also markedly reduced in the ERAS group (1.3% vs. 19.7%; p &lt; 0.001). The ERAS group was associated with a reduction in postoperative length of hospital stay by 2 days (p &lt; 0.001) and a decrease in hospital cost by 8065 RMB (p &lt; 0.001). Conclusions: Higher adherence to a locally adapted ERAS pathway was associated with fewer major complications, faster bowel recovery, shorter postoperative hospitalization, and lower hospital costs after elective open AAA repair. These findings support prospective multicenter evaluation and further context-specific implementation of ERAS in open aortic surgery.<\/jats:p>","DOI":"10.3390\/jcm15166486","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:20:36Z","timestamp":1787322036000},"page":"6486","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Adherence to a Locally Adapted Enhanced Recovery After Surgery Pathway and Perioperative Outcomes After Open Abdominal Aortic Aneurysm Repair: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Zhiyi","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghe","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingfeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.gheart.2013.12.009","article-title":"Estimation of global and regional incidence and prevalence of abdominal aortic aneurysms 1990 to 2010","volume":"9","author":"Sampson","year":"2014","journal-title":"Glob. Heart"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"znae279","DOI":"10.1093\/bjs\/znae279","article-title":"Outcomes of elective open surgical repair or fenestrated endovascular aneurysm repair for juxtarenal abdominal aortic aneurysms in Sweden","volume":"111","author":"Yu","year":"2024","journal-title":"Br. J. Surg."},{"key":"ref_3","first-page":"Cd014226","article-title":"Fenestrated endovascular repair for abdominal aortic aneurysms","volume":"5","author":"Daudu","year":"2025","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"McKechnie, T., Parpia, S., Bhandari, M., Dionne, J.C., and Eskicioglu, C. (2023). Enhanced Recovery After Surgery (ERAS) protocols following emergency intra-abdominal surgery: A systematic review and meta-analysis protocol. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0291140"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13037-024-00425-9","article-title":"Impact of \u201cEnhanced Recovery After Surgery\u201d (ERAS) protocols vs. traditional perioperative care on patient outcomes after colorectal surgery: A systematic review","volume":"19","author":"Kannan","year":"2025","journal-title":"Patient Saf. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1097\/MS9.0000000000004360","article-title":"Enhanced recovery after neurosurgery: A narrative review comparing clinical outcomes, protocols, and challenges with standard postoperative care","volume":"88","author":"Patel","year":"2026","journal-title":"Ann. Med. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"325","DOI":"10.3171\/2020.6.SPINE20795","article-title":"Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery","volume":"34","author":"Pennington","year":"2021","journal-title":"J. Neurosurg. Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"EVIDra2400012","DOI":"10.1056\/EVIDra2400012","article-title":"Enhanced Recovery after Surgery\u2014Evidence and Practice","volume":"4","author":"Elias","year":"2025","journal-title":"NEJM Evid."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1796","DOI":"10.1016\/j.jvs.2022.01.131","article-title":"Perioperative care in open aortic vascular surgery: A consensus statement by the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery","volume":"75","author":"McGinigle","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.ijsu.2016.11.088","article-title":"Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study","volume":"36","author":"Pisarska","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.jvs.2024.04.020","article-title":"Assessment of fitness for open repair in patients with infrarenal abdominal aortic aneurysms","volume":"80","author":"Khoury","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jvs.2017.10.044","article-title":"The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm","volume":"67","author":"Chaikof","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.jvs.2021.10.040","article-title":"A systematic review and meta-analysis on early mortality after abdominal aortic aneurysm repair in females in urgent and elective settings","volume":"75","author":"Nana","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ejvs.2020.09.002","article-title":"Editor\u2019s Choice\u2014Mortality is High Following Elective Open Repair of Complex Abdominal Aortic Aneurysms","volume":"61","author":"Latz","year":"2021","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_15","first-page":"2518","article-title":"hort and one-year outcome of endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAAs)","volume":"18","author":"Khosravi","year":"2022","journal-title":"ARYA Atheroscler."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"oa.25-00036","DOI":"10.5761\/atcs.oa.25-00036","article-title":"Machine Learning-Based Random Forest to Predict 3-Year Survival after Endovascular Aneurysm Repair","volume":"31","author":"Nishibe","year":"2025","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"OPTIMISE II Trial Group (2024). Cardiac output-guided haemodynamic therapy for patients undergoing major gastrointestinal surgery: OPTIMISE II randomised clinical trial. BMJ, 387, e080439.","DOI":"10.1136\/bmj-2024-080439"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13054-021-03464-1","article-title":"Association between perioperative fluid administration and postoperative outcomes: A 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral\/noncardiac surgery","volume":"25","author":"Messina","year":"2021","journal-title":"Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/s13054-021-03629-y","article-title":"Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: A systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery","volume":"25","author":"Messina","year":"2021","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/EJA.0000000000001615","article-title":"Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery: A pilot randomised controlled trial","volume":"39","author":"Chirnoaga","year":"2022","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s44158-021-00026-3","article-title":"Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: An updated meta-analysis","volume":"1","author":"Giglio","year":"2021","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.clnesp.2025.01.035","article-title":"Different regimens of preoperative carbohydrate loading on insulin resistance: A network meta-analysis","volume":"66","author":"Ping","year":"2025","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1002\/jpen.2633","article-title":"Trends in preoperative carbohydrate load practice: A systematic review","volume":"48","author":"Canelli","year":"2024","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Canzan, F., Longhini, J., Caliaro, A., Cavada, M.L., Mezzalira, E., Paiella, S., and Ambrosi, E. (2024). The effect of early oral postoperative feeding on the recovery of intestinal motility after gastrointestinal surgery: A systematic review and meta-analysis of randomized clinical trials. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1369141"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1136\/ijgc-2019-000991","article-title":"Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol","volume":"30","author":"Alimena","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1016\/j.soard.2021.04.014","article-title":"The influence of preoperative carbohydrate loading on postoperative outcomes in bariatric surgery patients: A randomized, controlled trial","volume":"17","author":"Suh","year":"2021","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chen, L., Wang, N., Xie, G., Wang, M., Yu, Y., Wang, H., and Fang, X. (2024). The safety of preoperative carbohydrate drinks in extremely elderly patients assessed by gastric ultrasonography: A randomized controlled trial. BMC Anesthesiol., 24.","DOI":"10.1186\/s12871-024-02457-1"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1097\/ALN.0000000000005535","article-title":"Sugammadex for Reversal of Neuromuscular Blockade in Neonates and Infants Less than 2 Years Old: Results from a Phase IV Randomized Clinical Trial","volume":"143","author":"Mukai","year":"2025","journal-title":"Anesthesiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1053\/j.jvca.2023.06.020","article-title":"Extubation in the Operating Room After Coronary Artery Bypass Graft Surgery Reduces Hospital Stay","volume":"37","author":"Borgomoni","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6486\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:31:58Z","timestamp":1787322718000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6486"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":29,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166486"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166486","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}