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DOI: 10.1055/s-0041-1725822
The Impact of Standardized ERAS (Enhanced Recovery after Surgery) Protocol in Patients undergoing Minimally Invasive Heart Valve Surgery
Objectives: ERAS (enhanced recovery after surgery) protocol is a pre-, intra-, and postoperative, multimodal strategy aiming to reduce postoperative complications and hospital length of stay (LOS) in a cost-effective way. Core elements are immediate extubation after surgery in the OR, early physical therapy under adjusted pain therapy and early hospital discharge with direct transfer to rehab. At our center, ERAS-protocol started in February 2018 in selected patients undergoing minimally invasive heart valve surgery. The data collected in this retrospective cohort analysis provides information about potential medical and economic benefits of ERAS protocol in minimally invasive heart valve surgery.
Methods: Non-randomized, retrospective cohort analysis. Pre-, intra-, and postoperative data of a total of 210 patients undergoing minimally invasive heart valve surgery. A total of 101 patients received treatment following ERAS protocol and 109 patients received routine care. The data contains information about pre-existing health condition, individual patient risk, measures of physical activity, type, and duration of surgery, convalescence, measures of pre- and postoperative echo and rehabilitation. Primary end-points were postoperative complications and hospital LOS, broken down into total LOS, ICU LOS, and postoperative LOS.
Result: Patients were predominantly men (77% in ERAS vs. 75% in control group) with low EuroSCORE II (0.836 vs. 0.808) and without differences in disease characteristics. In the ERAS group 47% of the patients had right lateral minithoracotomy (vs. 56% in the control group) and 54% had partial upper sternotomy (44% in control group). No intra- or perioperative complications were associated with ERAS-protocol. In-hospital mortality was 0% in both groups. There were no significant difference in the appearance of nosocomial infections (13% in ERAS versus 16% in control group, p = 0.48) and rehospitalization (17% readmissions from rehab in ERAS-group versus 9% in control group, p = 0.38). A significant decrease in hospital LOS (6.1 ± 2.6 vs. 7.7 ± 3.7 days, p = 0.005) as well as intensive care LOS (1.5 ± 1.1 vs. 2.1 ± 1.9 days, p = 0.019) in the ERAS cohort was shown.
Conclusion: Our ERAS protocol is safe and leads to quicker hospital discharge without compromising patient safety in patients undergoing minimally invasive heart valve surgery. Findings of this analysis shall prepare the setup of the INCREASE study, a randomized clinical trial, which is expected to provide high-quality data about the execution of ERAS protocol in the treatment of heart valve pathologies and their potential transfer into standard-of-care treatment.
Publication History
Article published online:
19 February 2021
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