• Judson B Williams, Gina McConnell, J Erin Allender, Patricia Woltz, Kathy Kane, Peter K Smith, Daniel T Engelman, and William T Bradford.
• WakeMed Health and Hospitals, Raleigh, NC; Duke University School of Medicine, Durham, NC. Electronic address: judson.williams@duke.edu.
• J. Thorac. Cardiovasc. Surg. 2019 May 1; 157 (5): 1881-1888.

ObjectiveOur 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.MethodsThe 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.ResultsComparing 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.ConclusionsInitial 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.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

37 keywords...

hide…