Cardiac Enhanced Recovery After Surgery: Early Outcomes in a Community Setting.

Abstract

BACKGROUND:

Enhanced Recovery After Surgery (ERAS) programs have demonstrated improved outcomes in noncardiac surgery. More recently, ERAS has been applied to cardiac surgery with promising results. We have implemented cardiac ERAS at our community-based program, aiming to improve all phases of care, and now report our early results.

METHODS:

We retrospectively analyzed 73 consecutive patients treated with ERAS care compared with 74 patients treated before implementing ERAS. Our ERAS program consisted of 6 perioperative care bundles including enhanced patient education, shortened preoperative fasting period and oral carbohydrate load, postoperative nausea prophylaxis, multimodal opioid-sparing analgesia, early extubation, and early mobilization.

RESULTS:

ERAS patients required significantly less opioids captured as total morphine milligram equivalents (MME) (median 35.0 vs 75.3; P < .001), less nausea as determined by fewer total ondansetron rescue doses (median 0 vs 0.5; P = .011), and less lightheadedness (P = .028) compared with pre-ERAS patients. Postoperative mobility was significantly better (postoperative day 4: 95% vs 81%; P = .013) and postoperative length of stay was lower for ERAS care but did not reach statistical significance (median 4 days vs 5 days; P = .06). There was no difference in pain or glucose control or in early extubation.

CONCLUSIONS:

Cardiac ERAS significantly decreased opioid use, nausea, and lightheadedness and improved functional outcome for cardiac surgical patients in a community hospital.

• Authors: Rawn Salenger, Sari D Holmes, Amanda Rea, Jennifer Yeh, Kate Knott, Rachel Born, Michael J Boss, Linda F Barr
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 113 Issue 6 Pg. 2008-2017 (06 2022) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 34352198 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid

Topics

• Analgesics, Opioid (therapeutic use)
• Dizziness
• Enhanced Recovery After Surgery
• Humans
• Length of Stay
• Nausea (drug therapy)
• Pain, Postoperative (drug therapy, prevention & control)
• Retrospective Studies