Feasibility of a Postanesthesia Care Unit-Based Enhanced Recovery Pathway after Elective Hemiarch Replacement with...

To assess the feasibility and safety of a postanesthesia care unit (PACU)-based Enhanced Recovery Pathway (ERP), following Enhanced Recovery after Cardiac Surgery (ERACS) Recommendations, after elective hemiarch replacement with circulatory arrest.

Retrospective, single-center observational study.

University-affiliated tertiary care hospital.

Adult patients undergoing elective hemiarch replacement with circulatory arrest (CA) managed using an ERP in the PACU between February 2013 and February 2025.

None.

Of 875 patients undergoing aortic arch surgery with CA, 152 were managed with the ERP. The vast majority (93.5%) of ERP patients were extubated within the first 6 hours postoperatively. ERP was successful in 125 patients (82.3%), while 27 patients experienced ERP failure. Compared with the ERP Success group, the ERP Failure group had a longer mean extubation time (223.7 ± 117 minutes vs 139.4 ± 63.3 minutes; p = 0.002), a longer hospital length of stay (17.4 ± 6.0 days vs 11.0 ± 4.7 days; p < 0.01), and a higher reintubation rate (44.4% vs 3.2%; p < 0.001). Independent predictors of ERP failure were intraoperative red blood cell transfusion (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.19-2.63; p = 0.005; cutoff ≥1 unit) and EuroSCORE II (OR, 1.13; 95% CI, 1.01-1.26; p = 0.033; cutoff ≥4.8). No in-hospital mortality occurred.

A PACU-based ERP following elective hemiarch replacement with CA appears to be feasible and safe. Successful ERP implementation was associated with efficient postoperative recovery and avoidance of intensive care unit admission in selected patients.