Background
Enhanced recovery after surgery (ERAS) can be summed up in a single word: optimization.
Optimization of the surgical outcome, which involves the management of a series of preoperative,
intraoperative, and postoperative variables. Optimization of our patient's health, both physically and
psychologically, and finally of resources by reducing length of hospital stay. Centered on the patient
and actively involving clinicians and the nursing staff, the aim is to standardize surgical management
with a care protocol, studied and accepted by means of a consensus of experts, which brings together
perioperative recommendations. This standardization also means individualizing care, by adapting to
the specific needs of each patient helping him or her to undergo an operation that is both biologically
and emotionally demanding. To highlight the benefits of the ERAS cardiac program at the CHUV which
began in 2023, the research team aimed to analyze the management of cardiac surgery patients before
the implementation of this protocol.
Method
We conducted a retrospective analysis in a cohort of 100 patients undergoing elective cardiac surgery
at CHUV in 2019. We excluded patients treated by TAVI, heart transplantation, ventricular-assist device
(VAD) implantation, and all emergency procedures. The year 2019 was chosen to avoid confounding
with COVID-19 crisis that largely impacted on elective surgery coordination. Data was extracted from
patient's electronic records, focusing on pre-
, intra and post-surgical parameters of the current cardiac
ERAS protocol.
Results
Overall, the mean age of the cohort was 66 years and 75% of patients were men. Patients frequently
presented classical cardiovascular risk factors, such as obesity, diabetes, hypertension, smoking and
excessive alcohol consumption. Most of the patients underwent bypass surgery or valve replacement
with extracorporeal circulation and aortic clamping. On admission in intensive care, half of the patients
in the cohort were already extubated, whereas for the others the median time of mechanical
ventilation was 1,8 hours. Patients spent an average of one day in the intensive care unit before being
transferred to the cardiac surgery intermediate care. The median duration of opioid use was three
days. Length of hospital stay was 13 days followed in most cases by transfer to a cardiac rehabilitation
center. The incidence of life-threatening post-surgical complications was very low. However, half of
the patients presented atrial fibrillation, 14 % developed pneumonia, and a high incidence of post-
surgical constipation was observed.
Conclusion
This retrospective study of a cohort including 100 patients with cardiac surgery in 2019 at the CHUV
illustrates the peri-operative management before the implementation of the cardiac ERAS protocol.
We noted positive aspects of this management, such as a short mechanical ventilation time and a very
low rate of severe complications in the pre-ERAS period. The results of this study allow us to depict
several aspects of perioperative management which deserve optimization. Firstly, there is room for
improvement in the pre-operative pathway of the patient, including optimized screening for frailty,
malnutrition or diabetes. Secondly, correction of pre-operative anemia can be improved, as well as
pre-operative counseling. Prevention of atrial fibrillation, , nausea and constipation in the post-
operative period, as well as early mobilization are further topics to be addressed and hopefully
improved with the implementation of the ERAS cardiac surgery protocol.