Postoperative enhanced recovery protocols improve outcomes post-cardiac surgery.

1. Postoperative enhanced recovery after surgery (ERAS) protocols for cardiac surgeries were found to improve outcomes such as decreasing the length of stay (LOS) and incidences of postoperative infections.

2. There was a significantly reduced 30-day mortality for patients who underwent open aortic surgeries after the implementation of ERAS protocols, compared to the pre-implementation cohort.

Evidence Rating Level: 2 (Good)

ERAS protocols provide guidelines for standardized perioperative pathways that aim to optimize patient care. In the field of cardiac surgery, the adoption of ERAS protocols has faced resistance due to the complexity of operations, acuity of patients, and paucity of literature surrounding its implementation. At Standford Hospital, ERAS post-operative care pathways for Coronary artery bypass graft (CABG)/Valve and Aortic surgeries have been established. This single-center retrospective cohort study aims to examine the impact of these protocols by comparing outcomes in the post-pathway implementation cohort with those who received care prior to implementation. For the CABG/Valve pathway, a total of 747 patients were propensity matched in the pre-and post-implementation cohorts. While there was no significant improvement in 30-day mortality, the post-implementation cohort had a significant decrease in the post-op LOS (7.0 vs. 6.0 days, p<0.001) and median ICU LOS (54.0 vs. 69.9 hours, p<0.001) compared to the pre-implementation cohort. Among other improvements like decreased duration of mechanical ventilation and faster return to ambulation, notably, there was also a decreased incidence of post-op ventilator-associated pneumonia (VAP) (p=0.003) and post-op urinary tract infections (UTIs) (p<0.001). For the Aortic Procedure pathway, a total of 586 patients were propensity-matched in the pre-and post-implementation cohorts. In contrast to the CABG/Valve cohorts, there was a significant decrease in 30-day mortality from 7% in the pre-implementation cohort to 3.5% in the post-implementation cohort (p=0.012), but no significant improvement in post-op or ICU LOS. While there was a significant decrease in the duration of mechanical ventilation and a significantly faster return to ambulation, there was no significant difference in the incidence of postop UTIs or VAPs. Overall, this study demonstrates that the implementation of ERAS protocols for cardiac surgeries at Standford Hospital decreases morbidity and LOS, and improves mortality for more critically ill patients who underwent open aortic operations. 

Click to read the study in PLOSONE

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