Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT.
Heart and Vascular Research Institute, Hartford Hospital, Hartford, CT.
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt A):2418-2431. doi: 10.1053/j.jvca.2022.02.027. Epub 2022 Feb 25.
To evaluate whether enhanced recovery after surgery (ERAS) protocol implementation was associated with improved outcomes and decreased racial and ethnic outcome disparities after isolated coronary artery bypass graft (CABG) surgery.
A retrospective analysis of an institutional CABG database with propensity-score matching.
At a single tertiary care teaching hospital.
One thousand seven hundred thirty-five patients undergoing isolated CABG: 656 patients from 2016 to 2017 (pre-ERAS) and 1,079 patients from 2018 to 2020 (post-ERAS). Each patient cohort was divided into a White subgroup and a racial and ethnic minorities (Minorities) subgroup.
None MEASUREMENTS AND MAIN RESULTS: Propensity-matched post-ERAS patients (n = 584) compared to pre-ERAS patients (n = 584) demonstrated reductions in total length of stay (LOS) (median [interquartile range]): (7 [5-10] v 8 [6-11.5] days, p = .006), postoperative LOS (5 [4-7] v 5 [4-7] days, p = .001), total ventilation time (6.1 [4.8-9.5] v 6.6 [5.2-10.9] hours, p = .004), postoperative morphine milligram equivalents (mean ± standard deviation: 68.6 ± 57.5 v 100.0 ± 59.4, p < .001), and increased likelihood of early extubation (48.8% v 42.3%, p = .026); the Minorities subgroup demonstrated reductions in likelihood of intensive care unit (ICU) readmission (1.3% v 8.1%, p = .012) and postoperative morphine milligram equivalents (73.6 ± 64.0 v 107.8 ± 71.9, p < .001). Logistic regression models demonstrated that disparities in ICU readmission and postoperative LOS between White and Minorities patients were eliminated post-ERAS.
ERAS for isolated CABG surgery was associated with reduced total and postoperative LOS, reduced total ventilation time, and increased early extubation for all patients, as well as reduced ICU readmission for the Minorities subgroup. ERAS implementation was associated with reduced disparities between White and racial and ethnic minority patients for ICU readmission and postoperative LOS.
评估术后强化康复（ERAS）方案的实施是否与孤立性冠状动脉旁路移植术（CABG）后改善结果和减少种族和民族结果差异有关。
对机构 CABG 数据库进行回顾性分析，并进行倾向评分匹配。
在一家三级保健教学医院。
1735 名接受孤立性 CABG 手术的患者：2016 年至 2017 年的 656 名患者（ERAS 前）和 2018 年至 2020 年的 1079 名患者（ERAS 后）。每个患者队列分为白人亚组和少数民族（少数民族）亚组。
无
与 ERAS 前患者（n=584）相比，ERAS 后患者（n=584）的总住院时间（LOS）（中位数[四分位距]）缩短：（7[5-10]天与 8[6-11.5]天，p=0.006），术后 LOS（5[4-7]天与 5[4-7]天，p=0.001），总通气时间（6.1[4.8-9.5]小时与 6.6[5.2-10.9]小时，p=0.004），术后吗啡毫克当量（平均值±标准差：68.6±57.5与 100.0±59.4，p<0.001），并且早期拔管的可能性增加（48.8%与 42.3%，p=0.026）；少数民族亚组的 ICU 再入院率（1.3%与 8.1%，p=0.012）和术后吗啡毫克当量（73.6±64.0与 107.8±71.9，p<0.001）降低。逻辑回归模型表明，白人患者和少数民族患者 ICU 再入院率和术后 LOS 之间的差异在 ERAS 后消除。
孤立性 CABG 手术的 ERAS 与所有患者的总 LOS 和术后 LOS 减少、总通气时间减少和早期拔管增加以及少数民族亚组的 ICU 再入院减少相关。ERAS 的实施与白人患者和少数民族患者之间 ICU 再入院率和术后 LOS 差异减少有关。
