Division of Cardiac Surgery, University of Maryland St. Joseph Medical Center, Towson, Maryland; Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2022 Jun;113(6):2008-2017. doi: 10.1016/j.athoracsur.2021.06.072. Epub 2021 Aug 2.
Enhanced Recovery After Surgery (ERAS) programs have demonstrated improved outcomes in noncardiac surgery. More recently, ERAS has been applied to cardiac surgery with promising results. We have implemented cardiac ERAS at our community-based program, aiming to improve all phases of care, and now report our early results.
We retrospectively analyzed 73 consecutive patients treated with ERAS care compared with 74 patients treated before implementing ERAS. Our ERAS program consisted of 6 perioperative care bundles including enhanced patient education, shortened preoperative fasting period and oral carbohydrate load, postoperative nausea prophylaxis, multimodal opioid-sparing analgesia, early extubation, and early mobilization.
ERAS patients required significantly less opioids captured as total morphine milligram equivalents (MME) (median 35.0 vs 75.3; P < .001), less nausea as determined by fewer total ondansetron rescue doses (median 0 vs 0.5; P = .011), and less lightheadedness (P = .028) compared with pre-ERAS patients. Postoperative mobility was significantly better (postoperative day 4: 95% vs 81%; P = .013) and postoperative length of stay was lower for ERAS care but did not reach statistical significance (median 4 days vs 5 days; P = .06). There was no difference in pain or glucose control or in early extubation.
Cardiac ERAS significantly decreased opioid use, nausea, and lightheadedness and improved functional outcome for cardiac surgical patients in a community hospital.
加速康复外科（ERAS）方案已证明可改善非心脏手术的结果。最近，ERAS 已应用于心脏手术并取得了可喜的结果。我们在社区医院实施了心脏 ERAS，旨在改善所有护理阶段，现在报告我们的早期结果。
我们回顾性分析了 73 例接受 ERAS 治疗的连续患者与 74 例在实施 ERAS 前接受治疗的患者。我们的 ERAS 方案包括 6 个围手术期护理包，包括增强患者教育、缩短术前禁食时间和口服碳水化合物负荷、术后恶心预防、多模式阿片类药物节约性镇痛、早期拔管和早期活动。
ERAS 患者需要的阿片类药物明显减少，表现为总吗啡毫克当量（MME）（中位数 35.0 对 75.3；P <.001），恶心减少，表现为总昂丹司琼解救剂量（中位数 0 对 0.5；P =.011），头晕减少（P =.028）。与 ERAS 前患者相比，术后活动能力明显更好（术后第 4 天：95%对 81%；P =.013），术后住院时间更短，但未达到统计学意义（中位数 4 天对 5 天；P =.06）。疼痛、血糖控制或早期拔管方面无差异。
心脏 ERAS 可显著减少社区医院心脏外科患者的阿片类药物使用、恶心和头晕，并改善其功能结果。
