One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program

Autor: Gina McConnell, William T. Bradford, J. Erin Allender, Peter K. Smith, Daniel T. Engelman, Judson B. Williams, Kathy Kane, Patricia Woltz
Rok vydání: 2019
Předmět:
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
Attitude of Health Personnel
Psychological intervention
030204 cardiovascular system & hematology
Perioperative Care
law.invention
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Enhanced recovery
Risk Factors
law
medicine
Humans
Hypoglycemic Agents
Insulin
Pain Management
Prospective Studies
Cardiac Surgical Procedures
Program Development
Delivery of Health Care
Integrated
business.industry
Recovery of Function
Perioperative
Length of Stay
Intensive care unit
United States
Cardiac surgery
Analgesics
Opioid
Staff satisfaction
Regimen
Treatment Outcome
030228 respiratory system
Patient Satisfaction
Anesthesia
Surgery
Diet
Carbohydrate Loading
Cardiology and Cardiovascular Medicine
business
Program Evaluation
Patient education
Zdroj: The Journal of Thoracic and Cardiovascular Surgery. 157:1881-1888
ISSN: 0022-5223
DOI: 10.1016/j.jtcvs.2018.10.164
Popis: Our enhanced recovery after cardiac surgery (ERAS Cardiac) program is an evidence-based interdisciplinary process, which has not previously been systematically applied to cardiac surgery in the United States.The Knowledge-to-Action Framework synthesized evidence-based enhanced recovery interventions and implementation of a designated ERAS Cardiac program. Standardized processes included (1) preoperative patient education, (2) carbohydrate loading 2 hours before general anesthesia, (3) multimodal opioid-sparing analgesia, (4) goal-directed perioperative insulin infusion, and (5) a rigorous bowel regimen. All cardiac anesthesiologists and surgeons agreed to follow the standardized pathway for adult cardiac surgery cases. The 1-year outcomes were compared between the 9 months pre- and post-ERAS Cardiac implementation using prospectively collected, retrospectively reviewed data.Comparing the pre- (N = 489) with the post- (N = 443) ERAS Cardiac groups, median postoperative length of stay was decreased from 7 to 6 days (P .01). Total intensive care unit hours were decreased from a mean of 43 to 28 hours (P .01). The incidence of gastrointestinal complications was 6.8% pre-ERAS versus 3.6% post-ERAS implementation (P .05). Opioid use was reduced by a mean of 8 mg of morphine equivalents per patient in the first 24 hours postoperatively (P .01). Reintubation rate and intensive care unit readmission rate were reduced by 1.2% and 1.5%, respectively (P = not significant). The incidence of hyperglycemic episodes was no different after ERAS Cardiac initiation. Patient satisfaction was 86.3% pre-ERAS versus 91.8% post-ERAS Cardiac implementation and work culture domain scores revealed increases in satisfaction across all measured indices, including patient focus, culture, and engagement.Initial clinical and survey data after the first year of a system-wide ERAS Cardiac program were associated with significantly improved perioperative outcomes. We believe this value-based approach to cardiac surgery can consistently result in earlier recovery, cost reductions, and increased patient/staff satisfaction.
Databáze: OpenAIRE
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