TY - JOUR

T1 - Results from an enhanced recovery program for cardiac surgery

AU - Johns Hopkins Enhanced Recovery Program for the Cardiac Surgery Working Group

AU - Grant, Michael C.

AU - Isada, Tetsuro

AU - Ruzankin, P.

AU - Whitman, G.

AU - Lawton, Jennifer S.

AU - Dodd-o, Jeffrey

AU - Barodka, Viachaslau

AU - Ibekwe, Stephanie

AU - Mihocsa, Andreas Bauer

AU - Gottschalk, A.

AU - Liu, Cecillia

AU - Mandal, Kaushik

N1 - Publisher Copyright: © 2019 The American Association for Thoracic Surgery

PY - 2020/4

Y1 - 2020/4

N2 - Objective: Enhanced recovery programs are multidisciplinary perioperative bundles of evidence-based process measures. Following the design and implementation of preanesthesia and intraoperative enhanced recovery programs for cardiac surgery guidelines, we evaluated the association between compliance and key clinical outcomes. Methods: Consecutive patients undergoing cardiac surgery at a single tertiary medical center from September 2017 to June 2018 were included. Patients were stratified into low (0-4 measures) and high (5-7 measures) compliance groups and then 1-to-3 propensity matched on the basis of 15 patient and surgical covariables. The primary outcome of interest was time to postoperative extubation. Secondary outcomes included interval time point extubation rates and intensive care unit, floor, and hospital lengths of stay. Results: A total of 451 patients were included in the study. After propensity matching (n = 315), patients in the high compliance group (n = 84) had a significant reduction in time to extubation (P < .001), floor length of stay (P = .01), and hospital length of stay (P = .03) compared with patients in the low compliance group (n = 231). Patients in the high compliance group were more likely to be extubated in the operating room (odds ratio, 35.8; 95% confidence interval, 10.66-168.75; P < .001) and within 6 hours of surgery (odds ratio, 2.6; 95% confidence interval, 1.18-6.07; P < .02). High compliance was associated with a median estimated time reduction of 3.4 hours to postoperative extubation (P < .001) and 19.4 hours in hospital length of stay (P = .01) compared with low compliance counterparts. There were no reintubations reported among patients extubated in the operating room (0/62 patients). Conclusions: There is value in developing phase-specific enhanced recovery programs guidelines, which improve rates of early extubation and affect the duration of stay after cardiac surgery. These results are hypothesis generating, and further prospective study is necessary to identify clinical impact of further program expansion.

AB - Objective: Enhanced recovery programs are multidisciplinary perioperative bundles of evidence-based process measures. Following the design and implementation of preanesthesia and intraoperative enhanced recovery programs for cardiac surgery guidelines, we evaluated the association between compliance and key clinical outcomes. Methods: Consecutive patients undergoing cardiac surgery at a single tertiary medical center from September 2017 to June 2018 were included. Patients were stratified into low (0-4 measures) and high (5-7 measures) compliance groups and then 1-to-3 propensity matched on the basis of 15 patient and surgical covariables. The primary outcome of interest was time to postoperative extubation. Secondary outcomes included interval time point extubation rates and intensive care unit, floor, and hospital lengths of stay. Results: A total of 451 patients were included in the study. After propensity matching (n = 315), patients in the high compliance group (n = 84) had a significant reduction in time to extubation (P < .001), floor length of stay (P = .01), and hospital length of stay (P = .03) compared with patients in the low compliance group (n = 231). Patients in the high compliance group were more likely to be extubated in the operating room (odds ratio, 35.8; 95% confidence interval, 10.66-168.75; P < .001) and within 6 hours of surgery (odds ratio, 2.6; 95% confidence interval, 1.18-6.07; P < .02). High compliance was associated with a median estimated time reduction of 3.4 hours to postoperative extubation (P < .001) and 19.4 hours in hospital length of stay (P = .01) compared with low compliance counterparts. There were no reintubations reported among patients extubated in the operating room (0/62 patients). Conclusions: There is value in developing phase-specific enhanced recovery programs guidelines, which improve rates of early extubation and affect the duration of stay after cardiac surgery. These results are hypothesis generating, and further prospective study is necessary to identify clinical impact of further program expansion.

KW - bundled health care

KW - cardiac surgical pathways

KW - enhanced recovery after surgery

KW - perioperative medicine

KW - quality improvement

KW - REDUCES OPIOID CONSUMPTION

KW - GUIDELINES

KW - TIME

KW - BYPASS GRAFT-SURGERY

KW - INTENSIVE-CARE-UNIT

KW - EARLY EXTUBATION

KW - PULMONARY COMPLICATIONS

KW - TRACHEAL EXTUBATION

KW - INTRAVENOUS ACETAMINOPHEN

KW - PERIOPERATIVE CARE

UR - http://www.scopus.com/inward/record.url?scp=85068250522&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.05.035

DO - 10.1016/j.jtcvs.2019.05.035

M3 - Article

C2 - 31279510

AN - SCOPUS:85068250522

VL - 159

SP - 1393-1402.e7

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 4

ER -