Results from an enhanced recovery program for cardiac surgery

Grant, Michael C.; Isada, Tetsuro; Ibekwe, Stephanie Opusunju; Mihocsa, Andreas Bauer; Ruzankin, Pavel; Gottschalk, Allan; Liu, Cecillia; Whitman, Glenn J.R.; Lawton, Jennifer S.; Mandal, Kaushik; Dodd‐o, Jeffrey M.; Barodka, Viachaslau

doi:10.1016/j.jtcvs.2019.05.035

Cited by 102 publications

(58 citation statements)

References 37 publications

(39 reference statements)

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“…There have been demonstrated improvements in patient-centered outcomes, lower costs, reduced intubation times, and shorter ICU and hospital lengths of stay at multiple cardiac centers (Table 1). [11][12][13][14][15] The potential benefits of ERPs demonstrated before COVID have become magnified as nonemergency surgeries across the surgical spectrum resume; hence, their inclusion in the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, and American Hospital Association joint statement on resuming elective surgery. 16 "Good enough" is no longer sufficient and time is of the essence.…”

Section: Cardiac Enhanced Recovery In the Era Of Covid-19mentioning

confidence: 99%

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Gregory

Grant²,

Boyle

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Cardiac Enhanced Recovery In the Era Of Covid-19mentioning

confidence: 99%

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Gregory

Grant²,

Boyle

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

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“…Grant et al 9 published a retrospective, propensity-matched study comparing 2 groups of patients: one with high compliance to ERACS protocols and one with low compliance. The primary outcome was time to extubation, and secondary outcomes included extubation rate at interval time points, as well as ICU, floor, and hospital LOS.…”

Section: Enhanced Recovery After Cardiac Surgerymentioning

confidence: 99%

Noteworthy Literature From 2019 for Cardiothoracic Critical Care

Shen

Tam

Jones

et al. 2020

Semin Cardiothorac Vasc Anesth

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“…One of the measures to improve post-operative outcome is oral carbohydrate loading (OCH) treatment, initiated to optimize the nutritional status of the patient prior to elective surgery as part of the Enhanced Recovery After Surgery (ERAS) pathway [ 21 , 22 , 23 ]. ERAS is a multimodal, multidisciplinary initiative to improve perioperative care with the effect of substantial improvements in clinical outcomes and cost savings [ 21 ].…”

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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Results from an enhanced recovery program for cardiac surgery

Cited by 102 publications

References 37 publications

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Noteworthy Literature From 2019 for Cardiothoracic Critical Care

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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