Effect of postoperative enhanced recovery program care compared to conventional care following aortic valve...

An enhanced recovery program (ERP) after cardiac surgery is a multidisciplinary care program aimed at reducing postoperative stress response, accelerating organ function recovery, and decreasing hospital length of stay (LOS). While ERP in cardiac surgery has shown promise, high-quality evidence remains limited.

This study evaluates the impact of a postanaesthesia care unit (PACU) care (including postoperative ERP interventions) vs. conventional intensive care unit (ICU) care in patients undergoing aortic valve replacement (AVR) on hospital LOS.

Retrospective cohort study with a Cox proportional hazards regression analysis, adjusting for BMI, EuroSCORE II and surgical access.

Single academic medical centre.

Patients undergoing AVR with EuroSCORE II =3 and BMI <40, admitted postoperatively to either the PACU or ICU between 2011 and 2020.

While pre-operative and intra-operative management were identical, postoperative care was protocolised in the PACU based on the Enhanced Recovery after Cardiac Surgery (ERAS Cardiac) pathway.

A total of 751 patients were included (345 receiving PACU care and 406 ICU care). The median hospital LOS (95% CI) was significantly shorter in the PACU care group (7 [6 to 9] vs. 9 [7 to 11] days, P < 0.0001) compared to ICU patients. PACU patients had a higher likelihood of early discharge [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.46 to 1.92; P < 0.0001] and earlier removal of catheters, tube and drains, with similar reintervention (PACU vs. ICU: 4% vs. 5%, P = 0.39) and mortality rates (1% in both, P = 0.51).

Compared with conventional ICU, PACU-ERP care was associated with a significant reduction in hospital LOS in low-risk patients undergoing AVR. These findings suggest integrating the postoperative elements of ERAS Cardiac as a standard of care. Nevertheless, further prospective studies are needed for validation.