Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Eur J Cardiothorac Surg. 2023 May 2;63(5). doi: 10.1093/ejcts/ezad125.
Evidence regarding the benefits of an enhanced recovery after cardiac surgery (ERACS) programme is lacking. The aim of this study was to analyse the impact of a systematic standardized ERACS programme for patients undergoing isolated elective surgical aortic valve replacement (SAVR) for aortic stenosis in terms of hospital mortality and morbidity, patient blood management and length of stay.
Patients undergoing isolated elective SAVR for aortic stenosis between 2015 and 2020 were identified from our database (n = 941). The standardized systematic ERACS programme was implemented in November 2018. Propensity score matching indicated that 259 patients would receive standard perioperative care (control group) and 259 patients would receive the ERACS programme (ERACS group). The primary outcome was hospital mortality. The secondary outcomes were hospital morbidity, patient blood management and length of stay.
Both groups had similar hospital mortality rates (0.4%). The ERACS group had a significantly lower troponin I peak level (P < 0.001), a larger proportion of improved perioperative left ventricular ejection fractions (P = 0.001), a lower incidence of bronchopneumonia (P = 0.030), a larger proportion of patients with mechanical ventilation <6 h (P < 0.001), a lower incidence of delirium (P = 0.028) and less acute renal failure (P = 0.013). The ERACS group had a significantly lower rate of red blood cell transfusions (P = 0.002). The intensive care unit stay was significantly shorter in the ERACS group than in the control group (P = 0.039).
The standardized systematic ERACS programme significantly improved postoperative outcomes and should become the reference for the perioperative care pathway for patients undergoing SAVR.
关于心脏手术后强化康复（ERACS）方案益处的证据尚不足。本研究旨在分析针对主动脉瓣狭窄患者行择期单纯外科主动脉瓣置换术（SAVR）的系统标准化 ERACS 方案对住院死亡率和发病率、患者血液管理和住院时间的影响。
从我们的数据库中确定了 2015 年至 2020 年间行择期单纯 SAVR 治疗主动脉瓣狭窄的患者（n=941）。2018 年 11 月实施了标准化系统 ERACS 方案。倾向评分匹配表明，259 例患者将接受标准围手术期护理（对照组），259 例患者将接受 ERACS 方案（ERACS 组）。主要结局为住院死亡率。次要结局为住院发病率、患者血液管理和住院时间。
两组的住院死亡率相似（0.4%）。ERACS 组肌钙蛋白 I 峰值水平显著降低（P<0.001），围手术期左心室射血分数改善比例更大（P=0.001），支气管肺炎发生率更低（P=0.030），机械通气时间<6 小时的患者比例更大（P<0.001），谵妄发生率更低（P=0.028），急性肾衰竭发生率更低（P=0.013）。ERACS 组红细胞输注率显著降低（P=0.002）。ERACS 组 ICU 停留时间明显短于对照组（P=0.039）。
标准化系统 ERACS 方案显著改善了术后结局，应成为 SAVR 患者围手术期护理途径的参考。
