Retrospective review of baseline practices prior to implementing an enhanced recovery programme

Enhanced recovery after surgery has an established evidence base in paediatric cardiac surgery, but formal programmes are infrequently implemented in Europe. Before implementing a programme, it is essential to assess current performance for benchmarking and to identify potential pitfalls.

A retrospective single-centre cohort study was performed to assess the peri-operative course of a low-risk group of children undergoing congenital cardiac surgery. Patient data were collected for the entire post-operative course before discharge home or to a different centre. Data regarding respiratory and haemodynamic support, invasive devices, length of stay, and analgesia were extracted from electronic intensive care records and paper ward records.

The search criteria yielded 1042 operations. Following a detailed assessment of inclusion and exclusion criteria, 73 patients were included in the study. Included patients had a median age of 3.1 years and a median weight of 13 kg. Seventy-one per cent (52/73) of patients underwent early extubation within six hours. Some children without contraindications did not receive non-opioid analgesia. Most invasive devices (pacing wires, drains, and central venous catheters) were removed on the ward. The median length of stay was 1.1 days in critical care and 4.3 in hospital.

Early extubation and duration of stay were comparable to outcomes published by some established enhanced recovery after surgery programmes, although shorter stays are achievable. Areas for improvement were identified. A centre's specific context must be considered when implementing aspects of an enhanced recovery after surgery programme.