Serious about C-ERAS (Cardiac ERAS)

Abstract

Enhanced Recovery After Surgery (ERAS) incorporates multi-modal interventions that synergistically improve patient outcome. Its goals include improving patients functionally pre-operatively, reducing the stress of surgery intra-operatively to facilitate early return to daily activities. We conducted a pilot study at our unit recruiting patients undergoing elective coronary artery bypass grafting (CABG) into the Cardiac ERAS (C-ERAS) pilot and compared them with the patients undergoing CABG meeting the ERAS criteria but who not included the C-ERAS pilot (Control).Materials and Methods: 122 C-ERAS patients were compared to 91 control patients who underwent CABG only from the period of July 2015 to September 2016. All C-ERAS patients received pre-operative counselling by a dedicated ERAS Practitioner to manage expectations of the patient journey, health promotion and pre-operative optimisation advice. Emphasis was made on educating the patient on daily goals for recovery and patients were followed up daily by the ERAS practitioner post-operatively.Results: There were 122 patients in the C-ERAS group and 91 patients in the control group. The mean age was 63.6±9.9 years. 181(85%) of the patients were males. After adjusting for the abovementioned confounders, C-ERAS patients had a shorter length of stay that was statistically significant. (2.36 days shorter (95% CI; 1.01-3.7 days; p<0.01). The difference in mean bed day costs was £1153.70 (95% CI, £553.70-£1753.7; p<0.01) less in the C-ERAS cohort. Conclusion:This study highlighted that C-ERAS is a safe and feasible pathway to reduce in-hospital stay with no difference in complications and readmission rates compared to routine management of patients. There was also a significant cost saving with the C-ERAS pathway mimicking the results in enhanced recovery programmes in the other surgical specialities.