Cedrick Zaouter1, Pierre Oses2, Savva Assatourian3, Louis Labrousse2, Alain Rémy3, Alexandre Ouattara4. 1. Department of Anesthesia and Critical Care, Magellan Medico-Surgical Centre, CHU Bordeaux Bordeaux, France. Electronic address: cedrick.zaouter@gmail.com. 2. Department of Cardiac Surgery, University Hospital of Bordeaux, Pessac, France. 3. Department of Anesthesia and Critical Care, Magellan Medico-Surgical Centre, CHU Bordeaux Bordeaux, France. 4. Department of Anesthesia and Critical Care, Magellan Medico-Surgical Centre, CHU Bordeaux Bordeaux, France; INSERM U1034 - Biology of Cardiovascular Diseases, University, Bordeaux, Pessac, France.
Abstract
OBJECTIVES: Presently, there is enthusiasm for the Enhanced Recovery After Surgery (ERAS) program. The literature clearly indicates this type of program could shorten hospital length of stay and improve patient outcome. However, most of the studies conducted have encompassed mainly colorectal and orthopedic surgeries. Thus, in an effort to provide more evidence to the literature, the authors prospectively investigated the feasibility and clinical effectiveness of a dedicated ERAS program for mini-invasive aortic valve replacements (MIAVRs). DESIGN: Observational before-and-after trial. SETTING: University hospital. PARTICIPANTS: Consecutive patients scheduled for an MIAVR via a mini-sternotomy during 2 time periods-before (MIAVR group) and after implementation of an ERAS program (MIAVR-ERAS group). INTERVENTIONS: Patients in the dedicated MIAVR-ERAS group followed a dedicated pathway specifically designed for this procedure, which encompasses several evidence-based medicine elements for cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Data on patient demographics, patient characteristics, compliance to the ERAS protocol, postoperative morphine consumption, postoperative pain scores, postoperative complications, hospital length of stay, and hospital readmission rate were collected and compared. Twenty-three patients were enrolled in each group. Patients enrolled in the new protocol had significantly lower postoperative pain scores (p = 0.03). The median hospital length of stay was 10 (9-13.5) and 7 (6.5-8) days in the traditional MIAVR group and in the MIAVR-ERAS group, respectively (p < 0.001). CONCLUSIONS: An ERAS pathway planned for MIAVR seems feasible and was associated with a shorter length of hospital stay with trends toward both less opioid consumption and less postoperative complications.
OBJECTIVES: Presently, there is enthusiasm for the Enhanced Recovery After Surgery (ERAS) program. The literature clearly indicates this type of program could shorten hospital length of stay and improve patient outcome. However, most of the studies conducted have encompassed mainly colorectal and orthopedic surgeries. Thus, in an effort to provide more evidence to the literature, the authors prospectively investigated the feasibility and clinical effectiveness of a dedicated ERAS program for mini-invasive aortic valve replacements (MIAVRs). DESIGN: Observational before-and-after trial. SETTING: University hospital. PARTICIPANTS: Consecutive patients scheduled for an MIAVR via a mini-sternotomy during 2 time periods-before (MIAVR group) and after implementation of an ERAS program (MIAVR-ERAS group). INTERVENTIONS:Patients in the dedicated MIAVR-ERAS group followed a dedicated pathway specifically designed for this procedure, which encompasses several evidence-based medicine elements for cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Data on patient demographics, patient characteristics, compliance to the ERAS protocol, postoperative morphine consumption, postoperative pain scores, postoperative complications, hospital length of stay, and hospital readmission rate were collected and compared. Twenty-three patients were enrolled in each group. Patients enrolled in the new protocol had significantly lower postoperative pain scores (p = 0.03). The median hospital length of stay was 10 (9-13.5) and 7 (6.5-8) days in the traditional MIAVR group and in the MIAVR-ERAS group, respectively (p < 0.001). CONCLUSIONS: An ERAS pathway planned for MIAVR seems feasible and was associated with a shorter length of hospital stay with trends toward both less opioid consumption and less postoperative complications.
Authors: Alexander J Gregory; Michael C Grant; Edward Boyle; Rakesh C Arora; Judson B Williams; Rawn Salenger; Subhasis Chatterjee; Kevin W Lobdell; Marjan Jahangiri; Daniel T Engelman Journal: J Cardiothorac Vasc Anesth Date: 2020-08-10 Impact factor: 2.628
Authors: Susanne G R Klotz; Gesche Ketels; Christian A Behrendt; Hans-Helmut König; Sebastian Kohlmann; Bernd Löwe; Johannes Petersen; Sina Stock; Eik Vettorazzi; Antonia Zapf; Inke Zastrow; Christian Zöllner; Hermann Reichenspurner; Evaldas Girdauskas Journal: Trials Date: 2022-06-23 Impact factor: 2.728