Enhancing Recovery in Congenital Cardiac Surgery
| Autor: | Morgan L. Brown, Lynn A. Sleeper, K. P. Mistry, M. Fernanda Parra, Meena Nathan, Barbara Rhodes, Pedro J. del Nido, Laura Carlson, Nathalie Roy |
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| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Heart disease medicine.medical_treatment Population Lower risk law.invention law Humans Medicine Cardiac Surgical Procedures Elective surgery education Retrospective Studies Mechanical ventilation Morphine Derivatives education.field_of_study business.industry Incidence (epidemiology) Length of Stay medicine.disease Intensive care unit Cardiac surgery Anesthesia Airway Extubation Surgery Enhanced Recovery After Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 114:1754-1761 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2021.09.040 |
| Popis: | The benefits of a comprehensive enhanced recovery after surgery (ERAS) program for patients with congenital heart disease are largely unknown. This study evaluated adherence and to outcomes of a recently implemented enhanced recovery program (ERP) in congenital cardiac surgery.Patients undergoing elective procedures for simple and moderately complex congenital cardiac surgery have followed institutional ERP guidelines since October 2018. Adherence to guidelines over a 12-month period (P2) was compared with implementation data (P1, 5 months). The association of outcomes with continuous time was estimated using linear regression.Among 559 patients (representing 40% of the cardiac surgical volume) following the ERP over a period of 17 months, no differences in patient characteristics were observed between periods, except a higher incidence of previous operations in P2. Adherence to many aspects of guidelines improved from P1 to P2. The following improvements were notable: operating room extubation, 27% in P2 vs16% in P1 (P = .006); and a decrease in median ventilation time, 6.0 hours (interquartile range [IQR], 0-9.2 hours) in P2 vs 7.6 hours (IQR, 3.8-12.3 hours) in P1 (P = .002). In addition, there was a reduction in opioids, reported as oral morphine equivalents, that was most significant for intraoperative oral morphine equivalents: 5.00 mg/kg (IQR, 3.11-7.60 mg/kg) in P2 vs 6.05 mg/kg (IQR, 3.77-9.78 mg/kg) in P1 (P = .001). There was no difference in overall intensive care unit and postoperative lengths of stay, except in lower-risk surgical procedures. Surgical outcomes were similar in the 2 periods.An enhanced recovery program reduced the use of opioids, led to more extubation in the operating room, and reduced mechanical ventilation duration in patients undergoing congenital cardiac surgery. |
| Databáze: | OpenAIRE |
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