TY - JOUR
T1 - Aggregation of Marginal Gains in Cardiac Surgery
T2 - Feasibility of a Perioperative Care Bundle for Enhanced Recovery in Cardiac Surgical Patients
AU - Fleming, Ian
AU - Garratt, Claire
AU - Guha, Ranj
AU - Desai, Jatin
AU - Chaubey, Sanjay
AU - Wang, Yanzhong
AU - Leonard, Sara
AU - Kunst, Gudrun
N1 - Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2016/6
Y1 - 2016/6
N2 - OBJECTIVES: The aim of this pilot study was to assess the feasibility of a perioperative care bundle for enhanced recovery after cardiac surgery (ERACS).DESIGN: A prospective, observational study.SETTING: A major urban teaching and university hospital and tertiary referral center.PARTICIPANTS: The study included 53 patients undergoing cardiac surgery before implementation of an ERACS protocol (pre-ERACS group) and 52 patients undergoing cardiac surgery after implementation of an ERACS protocol (ERACS group).INTERVENTIONS: Based on recommendations from a consensus review in colorectal surgery, the following enhanced recovery perioperative care bundle was applied: detailed preoperative information, avoidance of prolonged fasting periods preoperatively, preoperative carbohydrate beverages, optimization of analgesia with avoidance of long-acting opioids, prevention of postoperative nausea and vomiting, early enteral nutrition postoperatively, and early mobilization.MEASUREMENTS AND MAIN RESULTS: The authors hypothesized that length of hospital stay would be reduced with ERACS. Secondary outcome variables included a composite of postoperative complications and pain scores. Whereas the length of stay in the group of patients receiving the bundle of enhanced recovery interventions remained unchanged compared with the non-ERACS group, there was a statistically significant reduction in the number of patients in the ERACS group presenting with one or more postoperative complications (including hospital-acquired infections, acute kidney injury, atrial fibrillation, respiratory failure, postoperative myocardial infarction, and death). In addition, postoperative pain scores were improved significantly in the ERACS group.CONCLUSIONS: This pilot study demonstrated that ERACS is feasible and has the potential for improved postoperative morbidity after cardiac surgery. A larger multicenter quality improvement study implementing perioperative care bundles would be the next step to further assess outcomes in ERACS patients.
AB - OBJECTIVES: The aim of this pilot study was to assess the feasibility of a perioperative care bundle for enhanced recovery after cardiac surgery (ERACS).DESIGN: A prospective, observational study.SETTING: A major urban teaching and university hospital and tertiary referral center.PARTICIPANTS: The study included 53 patients undergoing cardiac surgery before implementation of an ERACS protocol (pre-ERACS group) and 52 patients undergoing cardiac surgery after implementation of an ERACS protocol (ERACS group).INTERVENTIONS: Based on recommendations from a consensus review in colorectal surgery, the following enhanced recovery perioperative care bundle was applied: detailed preoperative information, avoidance of prolonged fasting periods preoperatively, preoperative carbohydrate beverages, optimization of analgesia with avoidance of long-acting opioids, prevention of postoperative nausea and vomiting, early enteral nutrition postoperatively, and early mobilization.MEASUREMENTS AND MAIN RESULTS: The authors hypothesized that length of hospital stay would be reduced with ERACS. Secondary outcome variables included a composite of postoperative complications and pain scores. Whereas the length of stay in the group of patients receiving the bundle of enhanced recovery interventions remained unchanged compared with the non-ERACS group, there was a statistically significant reduction in the number of patients in the ERACS group presenting with one or more postoperative complications (including hospital-acquired infections, acute kidney injury, atrial fibrillation, respiratory failure, postoperative myocardial infarction, and death). In addition, postoperative pain scores were improved significantly in the ERACS group.CONCLUSIONS: This pilot study demonstrated that ERACS is feasible and has the potential for improved postoperative morbidity after cardiac surgery. A larger multicenter quality improvement study implementing perioperative care bundles would be the next step to further assess outcomes in ERACS patients.
KW - Aged
KW - Cardiac Surgical Procedures
KW - Feasibility Studies
KW - Female
KW - Humans
KW - Length of Stay
KW - Male
KW - Middle Aged
KW - Pain, Postoperative/physiopathology
KW - Perioperative Care
KW - Pilot Projects
KW - Prospective Studies
KW - Quality Improvement
KW - Recovery of Function
UR - http://www.scopus.com/inward/record.url?scp=84974777275&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2016.01.017
DO - 10.1053/j.jvca.2016.01.017
M3 - Article
C2 - 27321791
SN - 1053-0770
VL - 30
SP - 665
EP - 670
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
IS - 3
ER -