Results following implementation of a cardiac surgery ERAS protocol.
<h4>Introduction</h4>Adequate peri-operative care is essential to ensuring a satisfactory outcome in cardiac surgery. In this study, we look at the impact of evidence-based protocols implemented at Stanford Hospital.<h4>Methods</h4>This study is a single-center, retrospective...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0277868&type=printable |
| _version_ | 1797394488522440704 |
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| author | Tomi Obafemi Danielle Mullis Simar Bajaj Purnima Krishna Jack Boyd |
| author_facet | Tomi Obafemi Danielle Mullis Simar Bajaj Purnima Krishna Jack Boyd |
| author_sort | Tomi Obafemi |
| collection | DOAJ |
| description | <h4>Introduction</h4>Adequate peri-operative care is essential to ensuring a satisfactory outcome in cardiac surgery. In this study, we look at the impact of evidence-based protocols implemented at Stanford Hospital.<h4>Methods</h4>This study is a single-center, retrospective analysis. Enhanced recovery after surgery (ERAS) protocols were implemented for CABG/Valve and open Aortic operations on 11/1/2017 and 6/1/2018, respectively. Propensity-score matched analysis was used to compare 30-day mortality and morbidity of patients from the pre- and post-implementation cohorts. Secondary endpoints included the following: total hospital length of stay (LOS), ICU LOS, time until extubation, and time until urinary catheter removal.<h4>Results</h4>After the implementation of the ERAS protocols for CABG/Valve operations, the median post-op LOS decreased from 7.0 days to 6.1 days (p<0.001), and median ICU LOS decreased from 69.9 hours to 54.0 (p = 0.098). There was no significant decrease in 30-day mortality (4% to 3.3%, p = 0.47). However, the incidence of post-op ventilator associated pneumonia (VAP) decreased from 5.0% to 2.1% (p = 0.003) and post-op urinary tract infections (UTIs) from 8.3% to 3.6% (p<0.001). Patients who underwent open aortic procedures experienced an improvement in 30-day mortality (7% to 3.5%, p = 0.012), decrease in median ICU LOS (91.7 hours to 69.6 hours, p<0.001), and a decrease in duration of mechanical ventilation (79.3 hours to 46.3 hours, p = 0.003). There was a decrease in post-op LOS, post-op VAP, and post-op UTI, although statistical significance was not attained.<h4>Conclusion</h4>At Stanford Hospital, ERAS pathways have led to decreased morbidity and LOS while simultaneously improving mortality amongst our critically ill patient population. |
| first_indexed | 2024-03-09T00:20:31Z |
| format | Article |
| id | doaj.art-875bd9abba7d4ee2841f565308965b9e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-09T00:20:31Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-875bd9abba7d4ee2841f565308965b9e2023-12-12T05:35:04ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01187e027786810.1371/journal.pone.0277868Results following implementation of a cardiac surgery ERAS protocol.Tomi ObafemiDanielle MullisSimar BajajPurnima KrishnaJack Boyd<h4>Introduction</h4>Adequate peri-operative care is essential to ensuring a satisfactory outcome in cardiac surgery. In this study, we look at the impact of evidence-based protocols implemented at Stanford Hospital.<h4>Methods</h4>This study is a single-center, retrospective analysis. Enhanced recovery after surgery (ERAS) protocols were implemented for CABG/Valve and open Aortic operations on 11/1/2017 and 6/1/2018, respectively. Propensity-score matched analysis was used to compare 30-day mortality and morbidity of patients from the pre- and post-implementation cohorts. Secondary endpoints included the following: total hospital length of stay (LOS), ICU LOS, time until extubation, and time until urinary catheter removal.<h4>Results</h4>After the implementation of the ERAS protocols for CABG/Valve operations, the median post-op LOS decreased from 7.0 days to 6.1 days (p<0.001), and median ICU LOS decreased from 69.9 hours to 54.0 (p = 0.098). There was no significant decrease in 30-day mortality (4% to 3.3%, p = 0.47). However, the incidence of post-op ventilator associated pneumonia (VAP) decreased from 5.0% to 2.1% (p = 0.003) and post-op urinary tract infections (UTIs) from 8.3% to 3.6% (p<0.001). Patients who underwent open aortic procedures experienced an improvement in 30-day mortality (7% to 3.5%, p = 0.012), decrease in median ICU LOS (91.7 hours to 69.6 hours, p<0.001), and a decrease in duration of mechanical ventilation (79.3 hours to 46.3 hours, p = 0.003). There was a decrease in post-op LOS, post-op VAP, and post-op UTI, although statistical significance was not attained.<h4>Conclusion</h4>At Stanford Hospital, ERAS pathways have led to decreased morbidity and LOS while simultaneously improving mortality amongst our critically ill patient population.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0277868&type=printable |
| spellingShingle | Tomi Obafemi Danielle Mullis Simar Bajaj Purnima Krishna Jack Boyd Results following implementation of a cardiac surgery ERAS protocol. PLoS ONE |
| title | Results following implementation of a cardiac surgery ERAS protocol. |
| title_full | Results following implementation of a cardiac surgery ERAS protocol. |
| title_fullStr | Results following implementation of a cardiac surgery ERAS protocol. |
| title_full_unstemmed | Results following implementation of a cardiac surgery ERAS protocol. |
| title_short | Results following implementation of a cardiac surgery ERAS protocol. |
| title_sort | results following implementation of a cardiac surgery eras protocol |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0277868&type=printable |
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