Results from an Enhanced Recovery Program for Cardiac Surgery

Abstract Objective Enhanced Recovery Programs (ERPs) are multidisciplinary perioperative bundles of evidence-based process measures. Following the design and implementation of preanesthesia and intraoperative ERP 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 based upon 15 patient and surgical covariables. The primary outcome of interest was time to postoperative extubation. Secondary outcomes included interval time point extubation rates as well as intensive care unit (ICU), floor and hospital length of stay (LOS). 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 P = 0.01) and hospital LOS ( P = 0.03) compared to low compliance (n=231) patients. High compliance patients were more likely to be extubated in the operating room (Odds Ratio [OR] 35.8, 95% Confidence Interval [CI] 10.66-168.75; P P P P = 0.01) compared to low compliance counterparts. There were no reintubations reported among patients extubated in the operating room (0 of 62 patients). Conclusions There is value in developing phase-specific ERP guidelines, which improve rates of early extubation and impact the duration of stay following cardiac surgery. These results are hypothesis generating and further prospective study is necessary to identify clinical impact of further program expansion.