Division of Regional Anesthesia and Acute Pain, Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York.
Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
J Card Fail. 2021 Nov;27(11):1195-1202. doi: 10.1016/j.cardfail.2021.05.006. Epub 2021 May 26.
We sought to develop and implement a comprehensive enhanced recovery after surgery (ERAS) protocol for patients implanted with a left ventricular assist device (LVAD).
In this article, we describe our approach to the development and phased implementation of the protocol. Additionally, we reviewed prospectively collected data for patients who underwent LVAD implantation at our institution from February 2019 to August 2020. To compare early outcomes in our patients before and after protocol implementation, we dichotomized patients into two 6-month cohorts (the pre-ERAS and ERAS cohorts) separated from each other by 6 months to allow for staff adoption of the protocol. Of the 115 LVAD implants, 38 patients were implanted in the pre-ERAS period and 46 patients in the ERAS period. Preoperatively, the patients` characteristics were similar between the cohorts. Postoperatively, we observed a decrease in bleeding (chest tube output of 1006 vs 647.5 mL, P < .001) and blood transfusions (fresh frozen plasma 31.6% vs 6.7%, P = .04; platelets 42.1% vs 8.7%, P = .001). Opioid prescription at discharge were 5-fold lower with the ERAS approach (P < .01). Furthermore, the number of patients discharged to a rehabilitation facility decreased significantly (20.0% vs 2.4%, P = .02). The index hospitalization length of stay and survival were similar between the groups.
ERAS for patients undergoing LVAD implantation is a novel, evidence-based, interdisciplinary approach to care with multiple potential benefits. In this article, we describe the details of the protocol and early positive changes in clinical outcomes. Further studies are needed to evaluate benefits of an ERAS protocol in an LVAD population.Lay Summary: Enhanced recovery after surgery (ERAS) is the implementation of standardized clinical pathways that ensures the use of best practices and decreased variation in perioperative care. Multidisciplinary teams work together on ERAS, thereby enhancing communication among health care silos. ERAS has been used for more than 30 years by other surgical services and has been shown to lead to a decreased length of stay, fewer complications, lower mortality, fewer readmissions, greater job satisfaction, and lower costs. Our goal was to translate these benefits to the perioperative care of complex patients with a left ventricular assist device. Early results suggest that this goal is possible; we have observed a decrease in transfusions, discharge on opioids, and discharge to a rehabilitation facility.
我们旨在为植入左心室辅助装置（LVAD）的患者制定并实施全面的术后加速康复（ERAS）方案。
本文描述了我们制定和分阶段实施该方案的方法。此外，我们还回顾了 2019 年 2 月至 2020 年 8 月在我院植入 LVAD 的患者前瞻性收集的数据。为了比较方案实施前后患者的早期结果，我们将患者分为两个 6 个月的队列（ERAS 前和 ERAS 队列），每个队列之间相隔 6 个月，以确保工作人员接受该方案。在 115 例 LVAD 植入患者中，38 例患者在 ERAS 前期间植入，46 例患者在 ERAS 期间植入。术前，两组患者的特征相似。术后，我们观察到出血量减少（胸管引流量为 1006 与 647.5ml，P<0.001）和输血减少（新鲜冷冻血浆 31.6%与 6.7%，P=0.04；血小板 42.1%与 8.7%，P=0.001）。采用 ERAS 方法后，出院时阿片类药物的处方减少了 5 倍（P<0.01）。此外，出院至康复机构的患者数量显著减少（20.0%与 2.4%，P=0.02）。两组患者的住院时间和存活率相似。
LVAD 植入患者的 ERAS 是一种新的、基于证据的、多学科的护理方法，具有多种潜在益处。本文描述了该方案的细节以及临床结果的早期积极变化。需要进一步的研究来评估 ERAS 方案在 LVAD 人群中的益处。
术后加速康复（ERAS）是实施标准化临床路径的一种方法，可确保最佳实践的使用，并减少围手术期护理的差异。多学科团队共同开展 ERAS，从而增强了医疗保健孤岛之间的沟通。ERAS 已经被其他外科手术服务使用了 30 多年，并已被证明可以缩短住院时间、减少并发症、降低死亡率、减少再入院率、提高工作满意度和降低成本。我们的目标是将这些益处转化为接受左心室辅助装置治疗的复杂患者的围手术期护理。早期结果表明，这一目标是可行的；我们观察到输血减少、出院时使用阿片类药物以及出院到康复机构的人数减少。
