The influence of enhanced recovery after cardiac surgery on 30-day readmission rate, hospital and ICU length of stay

Abstract

Introduction Enhanced Recovery After Surgery (ERAS) pathways have been proven to increase patient satisfaction scores, decrease the complication rate, decrease the length of stay (LOS), and decrease cost for many surgical specialties. Recently, ERAS for cardiac surgery guidelines have been published and are being implemented in many centers. However, few data are reported on clinically important outcomes. We examined the effect of ERAS for cardiac patients on the duration of mechanical ventilation, ICU and hospital LOS.¹ Methods We retrospectively analyzed prospectively collected outcome data of patients undergoing cardiac surgery enrolled in the ERAS pathway (n = 115) compared to a historical standard care group (n = 188). The ERAS pathway included pre-operative patient education, multimodal pain management to minimize opioid usage, carbohydrate loading 2-4hrs before induction of anesthesia, minimizing crystalloid infusions, tight glucose control, early postoperative invasive access and chest tube removal, early extubation, and early mobilization. The standard care group was treated per preexisting institutional guidelines. Data were compared using univariate analysis: parametric and non-parametric data were analyzed with Student's t-test and Wilcoxon rank-sum test, respectively. A p-value of less than 0.05 was considered statistically significant. Results The median (25th, 75th) intensive care unit (ICU) length of stay (LOS) was 1 day (1, 2) in the ERAS group and 2 days (1, 3) in the standard care group (p Discussion The Enhanced Recovery Pathway after Surgery pathway uses a standardized approach to perioperative patient care. Implementation of ERAS for cardiac surgery results in shorter ICU and hospital LOS, comparable ICU and 30-day readmission rates, without a noticeable increase in 30-day mortality. Further studies focusing on other relevant outcome parameters are warranted.