Ronald Baxter1, John Squiers1, William Conner2, Michael Kent3, James Fann4, Kevin Lobdell5, J Michael DiMaio6. 1. Department of Surgery, Baylor University Medical Center, Dallas, Texas. 2. Cardiothoracic and Vascular Surgeons, PA, Austin, Texas. 3. Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 4. Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California. 5. Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina. 6. Department of Surgery, Baylor Scott and White, The Heart Hospital, Plano, Texas. Electronic address: michael.dimaio@bswhealth.org.
Abstract
BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a perioperative patient management strategy that is being adopted rapidly across surgical specialties worldwide. Components of ERAS work collaboratively throughout the perioperative course to achieve significant benefits for both the patient and the entire health care system. The use of ERAS in cardiac surgery (ERAS-C) could lead to similar improvements, but currently, use of ERAS-C programs is lacking and not well defined. METHODS: A literature search was performed of the Medline database to capture relevant studies discussing ERAS-C. Key concepts were extracted from these articles and grouped according to appropriate perioperative stages. Supporting literature was also included, briefly discussing the historical progression of cardiac surgery to enhanced recovery pathways, potential limitations to these pathways in cardiac surgery, and the first studies evaluating the use of an ERAS program with cardiac surgery patients. RESULTS: Initial results of ERAS-C studies have shown similar benefits to those of other surgical fields, including decreased hospital and intensive care unit lengths of stay (1-4 days and 4-20 hours, respectively), improved perioperative pain control (25%-60% decreased opioid usage), and improvements in early postoperative mobility and oral diets. Results especially beneficial to cardiac surgery have also been reported, such as an 8% to 14% decreased incidence of postoperative atrial fibrillation. CONCLUSIONS: This review presents pertinent current research related to the implementation of ERAS programs in the field of cardiac surgery and provides a call to action for further investigation and adaption of ERAS in cardiac surgery.
BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a perioperative patient management strategy that is being adopted rapidly across surgical specialties worldwide. Components of ERAS work collaboratively throughout the perioperative course to achieve significant benefits for both the patient and the entire health care system. The use of ERAS in cardiac surgery (ERAS-C) could lead to similar improvements, but currently, use of ERAS-C programs is lacking and not well defined. METHODS: A literature search was performed of the Medline database to capture relevant studies discussing ERAS-C. Key concepts were extracted from these articles and grouped according to appropriate perioperative stages. Supporting literature was also included, briefly discussing the historical progression of cardiac surgery to enhanced recovery pathways, potential limitations to these pathways in cardiac surgery, and the first studies evaluating the use of an ERAS program with cardiac surgery patients. RESULTS: Initial results of ERAS-C studies have shown similar benefits to those of other surgical fields, including decreased hospital and intensive care unit lengths of stay (1-4 days and 4-20 hours, respectively), improved perioperative pain control (25%-60% decreased opioid usage), and improvements in early postoperative mobility and oral diets. Results especially beneficial to cardiac surgery have also been reported, such as an 8% to 14% decreased incidence of postoperative atrial fibrillation. CONCLUSIONS: This review presents pertinent current research related to the implementation of ERAS programs in the field of cardiac surgery and provides a call to action for further investigation and adaption of ERAS in cardiac surgery.
Authors: Molly Szerlip; Deborah Tabachnick; Mohanad Hamandi; LuAnn Caras; Allison T Lanfear; John J Squiers; Katherine Harrington; Srinivasa P Potluri; J Michael DiMaio; Jordan Wooley; Benjamin Pollock; Justin M Schaffer; William T Brinkman; David L Brown; Michael J Mack Journal: Proc (Bayl Univ Med Cent) Date: 2020-09-23
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
Authors: Charles H Brown; Lisa Yanek; Ryan Healy; Tiffany Tsay; Junrui Di; Lee Goeddel; Daniel Young; Vadim Zipunnikov; Jennifer Schrack Journal: JTCVS Open Date: 2022-05-31