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Enhanced Recovery After Cardiac Surgery: A Propensity-Matched Analysis
Farhang Yazdchi1, Sameer Hirji1, Morgan Harloff1
1Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Seminars in Thoracic and Cardiovascular Surgery
|June 5, 2021
Summary
Enhanced Recovery After Surgery (ERAS) protocols in cardiac surgery significantly reduced ventilation times, intensive care unit (ICU) stays, and hospital length of stay (LOS). These improvements were achieved without compromising patient safety or outcomes, showing promising early results for ERAS cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Enhanced Recovery After Surgery (ERAS) pathways are established in non-cardiac surgery, improving outcomes and patient satisfaction.
- Adaptation of ERAS protocols in cardiac surgery is increasing but remains an evolving field.
- Early implementation of ERAS cardiac guidelines is crucial for optimizing patient recovery.
Purpose of the Study:
- To evaluate the early results of implementing ERAS cardiac surgery guidelines.
- To compare postoperative outcomes between patients managed with ERAS and propensity-matched controls.
Main Methods:
- Retrospective review of 102 patients managed with ERAS cardiac surgery guidelines (May 2018 - June 2019).
- Comparison with 76 propensity-matched controls from the pre-ERAS era (January 2017 - March 2019).
- Primary outcomes analyzed: ventilation time, ICU stay, and hospital length of stay (LOS).
Main Results:
- ERAS patients demonstrated significantly shorter median ventilation times (3.5 vs. 5.3 hours, p=.01).
- ERAS patients experienced significantly shorter median ICU stays (28 vs. 48 hours, p=.005).
- ERAS patients had significantly shorter median postoperative hospital LOS (5 vs. 6 days, p=.03) with no increase in readmissions or mortality.
Conclusions:
- Implementation of ERAS protocols in cardiac surgery is associated with reduced ventilation times, ICU stay, and hospital LOS.
- ERAS protocols appear to expedite postoperative recovery without compromising patient safety or key clinical outcomes.
- Further research is warranted to confirm the long-term benefits and consistency of ERAS algorithms in cardiac surgery.
