Effects of Implementing an Enhanced Recovery After Cardiac Surgery Protocol with On-Table Extubation on Patient...

Area of Science:

• Cardiac Surgery
• Enhanced Recovery After Surgery (ERAS) Protocols
• Perioperative Care

Background:

• ERAS protocols optimize surgical outcomes, reduce hospital length of stay (LOS), and lower costs.
• While established in colorectal surgery, ERAS is less common in cardiac surgery, particularly with on-table extubation (OTE).

Purpose of the Study:

• To evaluate a novel ERAS concept incorporating OTE (RERACS) in elective aortic valve replacement and coronary bypass surgery.
• To assess the impact of RERACS on postoperative recovery, complications, and patient satisfaction.

Main Methods:

• A monocentric study comparing a prospective RERACS group (n=114) with a retrospective standard care control group (n=119).
• RERACS involved perioperative measures including respiratory training, short fasting, and OTE.
• Key outcomes measured included postoperative LOS, duration of mechanical ventilation, vasoactive drug support, complication rates, and patient satisfaction.

Main Results:

• RERACS significantly reduced postoperative LOS (ICU and hospital) compared to standard care.
• Patients in the RERACS group experienced lower rates of nosocomial infections, postoperative cognitive dysfunction, nausea, and vomiting.
• Faster weaning from catecholamines and high patient satisfaction were observed in the RERACS group.

Conclusions:

• The RERACS concept, integrating ERAS principles with OTE, is safe and effective for elective cardiac surgery.
• This approach leads to faster recovery, reduced LOS, lower complication rates, and improved patient satisfaction.
• RERACS offers a promising strategy for optimizing perioperative care in low-risk cardiac surgery patients.