Patients' Experience With Enhanced Recovery After Cardiac Surgery

Enhanced recovery after surgery (ERAS) protocols in cardiac surgery can reduce length of stay and incidence of complications, but their impact on patients' experience is less known. We assessed patients' perioperative experience with cardiac ERAS.

We conducted a prospective, single-centre study on 191 consecutive patients undergoing cardiac surgery with ERAS. Questionnaires were administered preoperatively, at 6 weeks and 6 months postoperatively, assessing preoperative concerns, sources of information, education and prehabilitation, expectations vs reality for postoperative recovery, surgical satisfaction, and quality of life.

Preoperatively, pain was the most frequently reported concern. Face-to-face discussions with the surgical team were the most useful source of information, while use of online resources was low. From pre-assessment to surgery, alcohol unit consumption decreased 3-fold. Patients' median estimations for perioperative risks were mortality 3%, heart attack 5%, stroke 5%, wound infection 10%, and bleeding 5%. Actual pain scores for the first postoperative week were lower than expectations by 1 point on the Numeric Pain Scale, and surgical satisfaction was highest for in-hospital pain control. For the first postoperative month, patients expected to be functionally independent but found they required support with at least 1 activity of daily living. Physical health T-scores increased by 3.1 points at 6 months compared to baseline, whereas mental health scores increased by 2.5 points, meeting and approaching the minimal clinically important difference of 3, respectively.

Our cardiac ERAS protocol facilitates systematic prehabilitation and education. Improved counselling regarding perioperative risks, pain, and recovery may further reduce perioperative stress.

St. George's Hospital R&D Ref: AU0035.