Szerlip Molly, Tabachnick Deborah, Hamandi Mohanad, Caras LuAnn, Lanfear Allison T, Squiers John J, Harrington Katherine, Potluri Srinivasa P, DiMaio J Michael, Wooley Jordan, Pollock Benjamin, Schaffer Justin M, Brinkman William T, Brown David L, Mack Michael J
Cardiovascular Research Department, Baylor Scott and White The Heart Hospital, Plano, Texas.
General Surgery Department, Baylor University Medical Center, Dallas, Texas.
Proc (Bayl Univ Med Cent). 2020 Sep 23;34(1):5-10. doi: 10.1080/08998280.2020.1810198.
Enhanced recovery after surgery (ERAS) protocols are gaining wide acceptance. We evaluated ERAS protocol implementation in transfemoral transcatheter aortic valve replacement (TAVR) patients. The ERAS protocol included (1) moderate sedation or general anesthesia with on-table extubation, (2) no pulmonary artery or urinary catheters, (3) arterial line removal within 4 hours, (4) no postoperative narcotics, (5) mobilization at 4 hours and ambulation within 8 hours, and (6) antihypertensive reinstitution without nodal blockers. Patients who received TAVR before and after ERAS implementation were compared (N = 121 and N = 368, respectively). The primary endpoint was total hospital length of stay (LOS). ERAS patients had a lower mean Society of Thoracic Surgeons predicted risk of mortality (6.7% vs 7.5%; = 0.04). Unadjusted analysis demonstrated that ERAS was associated with significantly decreased mean LOS (2.8 vs 4.0 days, < 0.001), decreased 30-day mortality (0.8% vs 5.0%; = 0.003), and increased discharge home (90.2% vs 79.3%, = 0.002) with no increase in 30-day readmission (11.1% vs 14.0%, = 0.39). After risk adjustment, ERAS patients had a 1.87-day shorter LOS ( = 0.001) and trended toward increased discharge home (odds ratio 1.76, = 0.078) without increased readmission (odds ratio 0.74, = 0.4). An ERAS protocol for TAVR is safe and is associated with shorter LOS without increased readmission.
术后加速康复（ERAS）方案正获得广泛认可。我们评估了经股动脉经导管主动脉瓣置换术（TAVR）患者中ERAS方案的实施情况。ERAS方案包括：（1）适度镇静或全身麻醉并在手术台上拔管；（2）不放置肺动脉导管或尿管；（3）4小时内拔除动脉导管；（4）术后不使用麻醉性镇痛药；（5）4小时开始活动，8小时内下床行走；（6）重新使用抗高血压药物但不使用节点阻滞剂。对实施ERAS前后接受TAVR的患者进行了比较（分别为N = 121例和N = 368例）。主要终点是总住院时间（LOS）。接受ERAS的患者胸外科医师协会预测的平均死亡率较低（6.7%对7.5%；P = 0.04）。未经调整的分析表明，ERAS与平均LOS显著缩短（2.8天对4.0天，P < 0.001）、30天死亡率降低（0.8%对5.0%；P = 0.003）以及出院回家比例增加（90.2%对79.3%，P = 0.002）相关，且30天再入院率未增加（11.1%对14.0%，P = 0.39）。风险调整后，接受ERAS的患者LOS缩短1.87天（P = 0.001），出院回家的趋势增加（优势比1.76，P = 0.078），而再入院率未增加（优势比0.74，P = 0.4）。TAVR的ERAS方案是安全的，且与缩短LOS相关，同时不会增加再入院率。
