Enhanced Recovery After Cardiac Surgery: Gender Insights From an Ultra-Fast-Track Protocol

Ultra-fast-track (UFT) enhanced recovery after surgery (ERAS)-defined by on-table extubation, minimally invasive surgical technique and de-escalated ICU care-represents an intensified ERAS approach. Female patients remain under-represented in cardiac surgery research and experience worse postoperative outcomes. Therefore, we investigated possible gender-mediated differences in the outcomes of our UFT-ERAS program.

A total of 800 consecutive patients underwent UFT-ERAS for minimally invasive valve and aortic surgery at our institution from 01/2021 to 09/2024. Patients were divided by gender, and a retrospective cohort analysis was performed. The primary outcome was UFT-ERAS achievement, defined by a 0-5 score of postoperative milestones (on-table extubation, postoperative intermediate care, early physiotherapy, transfer to the general ward ≤24 h and hospital discharge ≤7 days). Secondary end points were major adverse cardiovascular events (MACE), reoperation for bleeding, reintubation, ICU readmission, acute kidney injury, atrial fibrillation, delirium and transfusion.

Women were older and had higher baseline risk scores. Overall, ERAS adherence and major postoperative complications were comparable between the sexes. Only discharge ≤7 days was less frequent, and postoperative transfusion need more frequent in women. In multivariable ordinal logistic regression adjusting for STS-PROM, age, and procedure type, sex was not independently associated with ERAS achievement (OR 0.88, 95% CI, 0.66-1.18).

In this predominantly low-risk patient cohort within a UFT-ERAS pathway, sex was not independently associated with overall ERAS achievement. However, women more frequently required transfusion and were less likely to be discharged within 7 days.