Interdisciplinary and cross-sectoral perioperative care model in cardiac surgery: implementation in the setting of minimally invasive heart valve surgery (INCREASE)—study protocol for a randomized controlled trial

Abstract

Background Valvular heart diseases are frequent and increasing in prevalence. Minimally invasive heart valve surgery embedded in an interdisciplinary enhanced recovery after surgery (ERAS) program may have potential benefits with regard to reduced length of stay and improved patient reported outcomes. However, no prospective randomized data exist regarding the superiority of ERAS program for the patients’ outcome. Methods We aim to randomize (1:1) a total of 186 eligible patients with minimally invasive heart valve surgery to an ERAS program vs. standard treatment at two centers including the University Medical Center Hamburg-Eppendorf, Germany, and the University Hospital Augsburg, Germany. The intervention is composed out of pre-, peri-, and postoperative components. The preoperative protocol aims at better preparation for the operation with regard to physical activity, nutrition, and psychological preparedness. Intraoperative anesthesiologic and surgical management are trimmed to enable an early extubation. Patients will be transferred to a specialized postoperative anesthesia care unit, where first mobilization occurs 3 h after surgery. Transfer to low care ward will be at the next day and discharge at the fifth day. Participants in the control group will receive treatment as usual. Primary endpoints include functional discharge at discharge and duration of in-hospital care during the first 12 months after index surgery. Secondary outcomes include health-related quality of life, health literacy, and level of physical activity. Discussion This is the first randomized controlled trial evaluating the effectiveness of an ERAS process after minimally invasive heart valve surgery. Interprofessional approach is the key factor of the ERAS process and includes in particular surgical, anesthesiological, physiotherapeutic, advanced nursing, and psychosocial components. A clinical implication guideline will be developed facilitating the adoption of ERAS model in other heart teams. Trial registration The study has been registered in ClinicalTrials.gov (NCT04977362 assigned July 27, 2021).

The impact of preoperative interview and prospective nursing on perioperative psychological stress and postoperative complications in patients undergoing TACE intervention for hepatocellular carcinoma

“…These activities can help patients relax and reduce feelings of tension and anxiety. [27][28][29][30] TACE intervention surgery is an invasive procedure, and the surgical incision can cause varying degrees of postoperative pain in patients. Additionally, the surgical process may stimulate the digestive system, thereby affecting postoperative digestive function.…”

Early outcome of endoscopic mitral valve surgery in elderly patients: a high-volume single center experience

“…Of note, reduced postoperative ventilation time in the control group may reflect recent implementation of an enhanced recovery after cardiac surgery (ERAS) protocol, including patients <70 years at our institution. Expansion of the ERAS protocol from younger to elderly patients may potentially be of clinical value, as elderly patients may specifically benefit from rapid extubation, early postoperative mobilization and reduced duration of in-hospital stay ( 28 ).…”

Patient-centered evaluation of an expectation-focused intervention for patients undergoing heart valve surgery: a qualitative study

“…The study was conducted as a qualitative follow-up of a randomized controlled trial (RCT) on the improvement of treatment for patients undergoing heart valve surgery ( 16 , for the study protocol; main manuscript under preparation). In this trial, N = 186 patients undergoing minimally invasive heart valve surgery were randomized to treatment as usual or to an interprofessional treatment following an Enhanced Recovery After Surgery (ERAS) protocol.…”

“…To further illustrate the effectiveness of expectation-focused interventions in different medical contexts and as the need for psychological support for patients undergoing heart valve surgery was identified in former studies, an expectation-focused intervention based on the EXPECT intervention and adapted for patients with heart valve surgery was conducted ( 6 , 7 , 15 ). The intervention was implemented into an interprofessional Enhanced Recovery After Surgery (ERAS) program within a randomized controlled trial (RCT) on the improvement of treatment for patients undergoing heart valve surgery ( 16 , for the study protocol; main manuscript under preparation). As the ERAS program was part of an RCT, a comparison between patients receiving the expectation-focused intervention and those receiving treatment as usual was possible.…”