Successful Implementation of Enhanced Recovery After Surgery (ERAS) in Paediatric Cardiac Surgery in Australia
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Published on: August 15, 2022
Shalom Andugala1, Amy McIntosh2, Jennifer Orchard2
1Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research, Centre for Children's Health Research, South Brisbane, Qld, Australia; School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Qld, Australia.
Insights
Enhanced recovery after surgery (ERAS) in paediatric cardiac surgery is feasible and safe, significantly reducing mechanical ventilation and hospital stay. This pathway optimizes resource use without increasing risks for low-risk patients.
Area of Science:
- Cardiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, evidence-based care pathway.
- ERAS protocols aim to optimize surgical patient recovery while minimizing risks.
- Previous studies indicate ERAS reduces mechanical ventilation and ICU length of stay (LOS) in pediatric cardiac surgery.
Purpose of the Study:
- To present the first structured implementation of ERAS in pediatric cardiac surgery in Australia.
- To evaluate the feasibility and safety of the ERAS pathway in this population.
- To compare outcomes between ERAS and non-ERAS patients.
Main Methods:
- Retrospective and prospective data collection for 121 ERAS patients (Oct 2019-Jul 2023).
- Propensity-matched control group of non-ERAS patients.
- Outcomes assessed: mechanical ventilation duration, ICU LOS, hospital LOS, reinterventions, complications, and readmissions.
Main Results:
- The majority of ERAS patients (89.3%) were extubated in the operating theatre.
- ERAS patients had significantly shorter mechanical ventilation duration, ICU LOS, and hospital LOS compared to controls.
- No significant differences were observed in ICU readmission, reintervention, complication, or 30-day readmission rates.
Conclusions:
- ERAS is feasible and safe for select low-risk pediatric cardiac surgery patients.
- The ERAS pathway effectively reduces postoperative mechanical ventilation and LOS.
- Implementation of ERAS optimizes resource utilization in pediatric cardiac surgery.
Background & Aim:
Fast-track or enhanced recovery after surgery (ERAS) is a care pathway for surgical patients based on a multidisciplinary team approach aimed at optimising recovery without increasing risk with protocols based on scientific evidence, which is monitored continuously to ensure compliance and improvement. These protocols have been shown to reduce the duration of postoperative mechanical ventilation and intensive care unit (ICU) length of stay (LOS) following paediatric cardiac surgery. We present the first structured implementation of ERAS in paediatric cardiac surgery in Australia.
Methods:
All patients enrolled in the ERAS pathway between October 2019 and July 2023 were identified. Demographic and perioperative data were collected retrospectively from hospital records for patients operated before June 2021 and prospectively from June 2021. A control group (non-ERAS) was identified using propensity matching from patients who underwent similar procedures and were not enrolled in the ERAS pathway (prior to October 2019). Patients were matched for age, weight, and comprehensive Aristotle score. Outcomes of interest were duration of postoperative mechanical ventilation, ICU LOS, readmission to the ICU, hospital LOS, cardiac reintervention rate, postoperative complication rate, and number of 30-day readmissions.
Results:
Of 1,084 patients who underwent cardiac surgery during the study period (October 2019-July 2023), 121 patients (11.2%) followed the ERAS pathway. The median age at the time of surgery was 4.8 years (interquartile range [IQR] 2.8-8.8 years). The most common procedure was the closure of atrial septal defect (n=58, 47.9%). The median cardiopulmonary bypass and cross-clamp times were 40 min (IQR 28-53.5 minutes) and 24.5 min (IQR 13-34 minutes) respectively. The majority were extubated in the operating theatre (n=108, 89.3%). The median ICU and hospital LOS were 4.5 hrs (IQR 4.1-5.6 hours) and 4 days (IQR 4-5 days) respectively. None of the patients required readmission to the ICU within 24 hrs of discharge from the ICU. Three (3) patients (2.5%) required reintervention. When compared with the non-ERAS group, the duration of postoperative mechanical ventilation, ICU and hospital LOS were significantly lower in the ERAS group. There was no significant difference in the ICU readmission rate, reintervention rate, complication rate, and number of 30-day readmissions between both groups.
Conclusions:
ERAS after paediatric cardiac surgery is feasible and safe in select patients with low preoperative risk. This pathway reduces the duration of postoperative mechanical ventilation, ICU and hospital LOS without increasing risks, enabling the optimisation of resources.
