Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial

Li, Man; Zhang, Junjie; Gan, Tong J.; Qin, Gang; Wang, Lu; Zhu, Maoen; Zhang, Zhong; Pan, Yundan; Liu, Yang; Zhang, Fan; Chen, Xuliang; Lin, Guo‐Qiang; Huang, Lei; Luo, Wanjun; Guo, Qulian; Wang, E

doi:10.1093/ejcts/ezy100

Cited by 128 publications

(88 citation statements)

References 23 publications

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“…EA is also an effective candidate intervention for preventing the occurrence of multiple organ complications post-surgery. Li et al reported that ERAS effectively brought forward the time of first bowel movement about 1.0 day [32]. Our data also confirmed that PEA promoted gastrointestinal function recovery, with an average reduction of first bowel movement for 0.7 day.…”

Section: Discussionsupporting

confidence: 87%

“…Given that an imprudent "changing of the guard" is a justifiable concern with any practice update, there have been concerns that old dogma, different types of surgery and minimal peer-reviewed evidence from multiple subjects, will be maladaptation under the umbrella of "enhanced recovery" without validation in cardiac rehabilitation. Meanwhile, considering the advanced age was often accompanied with stroke, chronic obstructive pulmonary disease, and renal dysfunction, and complications such as fragile, pain and tube contamination were inevitable after OPCABG, EA was quite a difficult task to perform efficiently after cardiac surgery [12,13]. Yet, the feasibility of start time and the appropriate intensity level of physical rehabilitation for patients with cardiovascular limitations is still unknown.…”

Section: Introductionmentioning

confidence: 99%

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Precision implementation of early ambulation in elderly patients underwent off-pump coronary artery bypass graft surgery: a randomized controlled clinical trial

Cui

Fan

et al. 2020

Preprint

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Background Though early ambulation (EA) is associated with improved outcomes for post-operative patients, precision initiative on EA for elderly patients has rarely been reported. The aim of this study is to determine the safety and effectiveness of precision implementation of EA in elderly patients underwent off-pump coronary artery bypass graft (OPCABG) surgery. Methods We conducted a single-center, randomized and controlled clinical trial involving elderly patients(≥60 years) in who EA support was implemented after OPCABG surgery. Patients were randomly assigned to precision early ambulation (PEA) group or routine ambulation (Control) group. Innovatively referring age-predicted maximal heart rate (APMHR) and VO 2max was the highlight of PEA. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-point included 90-day mortality, laboratory test, length of stay in ICU, the incidence of multiple organ complications as well as post-traumatic stress disorder (PTSD). Results There were 178 patients were enrolled, with 89 patients assigned to receive PEA and 89 to receive control procedure. By intent-to-treat analysis, during PEA program, participants performed a much longer distance of ambulation on the third day ( P =0.000). Mild-to-moderate physical activity in PEA group ameliorates PLOS ( P =0.031), Time of first bowel ( P =0.000) and partial pressure O 2 ( P g =0.001). Additionally, patients in PEA group showed significantly lower incidence of PTSD than those in Control group ( P =0.000). Conclusion APMHR and VO 2max are valuable for target intensity and exercise formula. PEA after OPCAPG surgery is safe and reliable for elderly patients, which not only reduces the hospital stay but also improves patients’ postoperative functional status.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Precision implementation of early ambulation in elderly patients underwent off-pump coronary artery bypass graft surgery: a randomized controlled clinical trial

Cui

Fan

et al. 2020

Preprint

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“…The threatening diagnosis, uncertainty surrounding surgery outcomes, patients’ social networks and malnutrition could be causal for their feelings of depression (Zargar‐Shoshtari & Hill, ). Physical, psychological, social, and emotional aspects of these patients’ recovery process need to be assessed prospectively, to identify those with impaired recovery after surgery and enable development and implementation of enhanced recovery after surgery pathways, which have shown similar positive results across different surgical specialties (Li et al, ; Nicholson et al, ).…”

Section: Discussionmentioning

confidence: 99%

Understanding patients’ experiences of recovery after staged complex aortic repair: A phenomenological study

Haakseth

Wanhainen

Björck

et al. 2019

Journal of Advanced Nursing

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Aim To explore patients’ with complex aortic diseases lived experiences of recovery between and after staged endovascular aortic repair (EVAR) procedures, including adjunctive open surgery. Design Qualitative descriptive phenomenological design, applying person‐centred care and lifeworld‐led health care. Methods Patients operated on in a staged fashion between 2012–2017 were invited to participate. Six participants underwent in‐depth interviews 1–5 years postoperatively. The interviews were analysed using descriptive phenomenological method. Findings The essence of the patients’ experiences was described as: a necessary, overwhelming, hard, and prolonged process with life changing consequences. Between the operations: expected tiredness where life goes on as usual and insufficient time for recovery. Short‐term after all operations: overwhelming tiredness, pain and complications, mostly from neurological deficits. Losing ‘yourself’ and struggling to manage daily life one day to another. Long‐term after all operations: gradually recovering back to ‘yourself’ and having to accept life with permanent setbacks and limitations. Conclusion Patients with complex aortic diseases struggle with physical and psychological setbacks, continuing years after their operations. There is a need to prospectively assess different aspects of these patients’ recovery, identify those with impaired recovery and establish preventive and supporting strategies. Impact Patients’ experience of recovery after staged aortic repair has not previously been investigated. The findings indicate that these patients struggle with various physical and psychological setbacks continuing years after their operations. These results will inform further research on this group of patients and guide healthcare professionals in the care of these patients in their transition back to recovery.

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“…ERAS is a multimodal, multidisciplinary initiative to improve perioperative care with the effect of substantial improvements in clinical outcomes and cost savings [ 21 ]. It is especially relevant to cardiac surgery and includes issues related to human nutrition and metabolism during the preoperative preparation (fasting, preoperative carbohydrate treatment), intraoperative management (blood glucose monitoring and treatment) and postoperative approach (treatment of nausea and vomiting, early nutrition and gastrointestinal stimulation) [ 22 , 24 , 25 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

et al. 2020

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Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.

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Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial

Abstract: ClinicalTrials.gov: NCT02479581.

Cited by 128 publications

References 23 publications

Precision implementation of early ambulation in elderly patients underwent off-pump coronary artery bypass graft surgery: a randomized controlled clinical trial

Precision implementation of early ambulation in elderly patients underwent off-pump coronary artery bypass graft surgery: a randomized controlled clinical trial

Understanding patients’ experiences of recovery after staged complex aortic repair: A phenomenological study

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

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