Reduced Length of Hospital Stay for Cardiac Surgery-Implementing an Optimized Perioperative Pathway: Prospective Evaluation of an Enhanced Recovery After Surgery Program Designed for Mini-Invasive Aortic Valve Replacement.

ABSTRACT

OBJECTIVES: Presently, there is enthusiasm for the Enhanced Recovery After Surgery (ERAS) program. The literature clearly indicates this type of program could shorten hospital length of stay and improve patient outcome. However, most of the studies conducted have encompassed mainly colorectal and orthopedic surgeries. Thus, in an effort to provide more evidence to the literature, the authors prospectively investigated the feasibility and clinical effectiveness of a dedicated ERAS program for mini-invasive aortic valve replacements (MIAVRs). DESIGN: Observational before-and-after trial. SETTING: University hospital. PARTICIPANTS: Consecutive patients scheduled for an MIAVR via a mini-sternotomy during 2 time periods-before (MIAVR group) and after implementation of an ERAS program (MIAVR-ERAS group). INTERVENTIONS: Patients in the dedicated MIAVR-ERAS group followed a dedicated pathway specifically designed for this procedure, which encompasses several evidence-based medicine elements for cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Data on patient demographics, patient characteristics, compliance to the ERAS protocol, postoperative morphine consumption, postoperative pain scores, postoperative complications, hospital length of stay, and hospital readmission rate were collected and compared. Twenty-three patients were enrolled in each group. Patients enrolled in the new protocol had significantly lower postoperative pain scores (p = 0.03). The median hospital length of stay was 10 (9-13.5) and 7 (6.5-8) days in the traditional MIAVR group and in the MIAVR-ERAS group, respectively (p < 0.001). CONCLUSIONS: An ERAS pathway planned for MIAVR seems feasible and was associated with a shorter length of hospital stay with trends toward both less opioid consumption and less postoperative complications.