Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Departments of Surgery, Anaesthesia, and Pediatrics, Harvard Medical School, Boston, Massachusetts.
Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Departments of Surgery, Anaesthesia, and Pediatrics, Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 2022 Nov;114(5):1754-1761. doi: 10.1016/j.athoracsur.2021.09.040. Epub 2021 Oct 25.
The benefits of a comprehensive enhanced recovery after surgery (ERAS) program for patients with congenital heart disease are largely unknown. This study evaluated adherence and to outcomes of a recently implemented enhanced recovery program (ERP) in congenital cardiac surgery.
Patients undergoing elective procedures for simple and moderately complex congenital cardiac surgery have followed institutional ERP guidelines since October 2018. Adherence to guidelines over a 12-month period (P2) was compared with implementation data (P1, 5 months). The association of outcomes with continuous time was estimated using linear regression.
Among 559 patients (representing 40% of the cardiac surgical volume) following the ERP over a period of 17 months, no differences in patient characteristics were observed between periods, except a higher incidence of previous operations in P2. Adherence to many aspects of guidelines improved from P1 to P2. The following improvements were notable: operating room extubation, 27% in P2 vs16% in P1 (P = .006); and a decrease in median ventilation time, 6.0 hours (interquartile range [IQR], 0-9.2 hours) in P2 vs 7.6 hours (IQR, 3.8-12.3 hours) in P1 (P = .002). In addition, there was a reduction in opioids, reported as oral morphine equivalents, that was most significant for intraoperative oral morphine equivalents: 5.00 mg/kg (IQR, 3.11-7.60 mg/kg) in P2 vs 6.05 mg/kg (IQR, 3.77-9.78 mg/kg) in P1 (P = .001). There was no difference in overall intensive care unit and postoperative lengths of stay, except in lower-risk surgical procedures. Surgical outcomes were similar in the 2 periods.
An enhanced recovery program reduced the use of opioids, led to more extubation in the operating room, and reduced mechanical ventilation duration in patients undergoing congenital cardiac surgery.
全面的术后强化康复（ERAS）方案对先天性心脏病患者的益处尚不清楚。本研究评估了最近实施的先天性心脏手术强化康复方案（ERP）的依从性和结果。
自 2018 年 10 月以来，择期行简单和中度复杂先天性心脏手术的患者遵循机构 ERP 指南。比较了 12 个月期间（P2）的指南依从性与实施数据（P1，5 个月）。使用线性回归估计结局与连续时间的关联。
在 17 个月的时间里，559 例（占心脏外科手术量的 40%）患者遵循 ERP，两个时期的患者特征无差异，除了 P2 期有更多的既往手术。从 P1 到 P2，许多指南方面的依从性都有所提高。以下改进值得注意：手术室拔管，P2 期为 27%，P1 期为 16%（P=0.006）；以及通气时间中位数的减少，P2 期为 6.0 小时（四分位距[IQR]，0-9.2 小时），P1 期为 7.6 小时（IQR，3.8-12.3 小时）（P=0.002）。此外，阿片类药物（以口服吗啡当量报告）的用量减少，术中口服吗啡当量的减少最为显著：P2 期为 5.00mg/kg（IQR，3.11-7.60mg/kg），P1 期为 6.05mg/kg（IQR，3.77-9.78mg/kg）（P=0.001）。两个时期的总体重症监护病房和术后住院时间无差异，但低危手术除外。两个时期的手术结果相似。
强化康复方案减少了阿片类药物的使用，导致手术室拔管更多，并减少了先天性心脏病患者机械通气的持续时间。
