135: ENHANCED RECOVERY AFTER CARDIAC SURGERY (ERACS): A PILOT STUDY

Abstract

Introduction: Surgery is known to cause extreme insults to the body such as increasing oxygen demand, end organ ischemia, and depletion of energy stores. Enhanced Recovery After Surgery (ERAS) is an evidence-based improvement process for surgical procedures. This study aims to evaluate the current policy and procedure used in patients undergoing open heart surgery with the ERACS treatment algorithm developed by the team of intensivists and surgeons at AdventHealth Celebration. Methods: This was a retrospective chart review of patients who underwent a physician approved Enhanced Recovery After Cardiac Surgery protocol at AdventHealth celebration. Patients were enrolled into the protocol-based inclusion criteria. Data was obtained from January 2021 through September 2021. The primary outcome sought to evaluate time to extubation from mechanical ventilation post-operatively. Secondary outcomes include time to reintubation if applicable, intensive care unit length of stay, post-operative length of stay, and 30-day mortality. Outcomes were compared to the historical cohort which was the population prior to implementation between July 2019 through December 2020. Results: A total of 50 patients were included in the study population who received the ERACS protocol compared 241 in the historical cohort. The ERACS cohort had a 100% successful extubation within less than six hours compared to 84.2% in the historical cohort (p < 0.05). Re-intubation post-operatively was 0% compared to 4.35% in the ERACS compared to historical cohort respectively (p < 0.05). ICU length of stay was significantly shorter than in the ERACS compared to historical cohort 24 compared to 53.28 hours (p < 0.05). No statistical difference was detected between both groups for post-op length of stay being 141.6 compared to 144 hours in the ERACS vs historical cohort respectively (p=0.24). No statistical difference noted between 30-day all-cause mortality 0% compared to 2.5% in the ERACS compared to historical cohort respectively (p=0.11). Conclusions: Statistical and clinical significance was observed with respect to the cohorts. This was most notably seen with the primary outcome, time to extubation, a nationally measured Society of Thoracic Surgery metric. Differences were also noted in re-intubation rates post-operatively and ICU length of stay.