Impact of the Enhanced Recovery After Surgery Program on Outcomes After Cardiac Surgery: One-Year Results

Abstract

Background: To evaluate the clinical impact of enhanced recovery after surgery (ERAS) protocols implementation in the cardiac surgery department at Lausanne University Hospital (CHUV) comparing outcomes between a prospective ERAS cohort and a retrospective cohort from 2019.

Patients and methods: A prospective cohort of 228 patients undergoing elective cardiac surgery with ERAS protocols between May 2023 and August 2024 was compared to a retrospective cohort of 162 patients from 2019. Inclusion criteria included on-pump adult elective cardiac surgery patients via median sternotomy. Propensity score matching was applied based on six variables: age, sex, EuroSCORE II, type of surgery, previous cardiac surgery, and cardiopulmonary by-pass duration, resulting in two matched groups of 125 patients each.

Results: After matching, the ERAS group showed a significant reduction in median hospital length of stay from 11.0 to 9.0 days (p = 0.002). The proportion of patients free from any of the defined complications increased in the ERAS group from 43.2% to 61.7% (p = 0.006), indicating an overall reduction in postoperative morbidity. ERAS implementation independently increased odds of being complication-free (OR 2.88 and p < 0.001). Opioid use on postoperative day 2 decreased from 9.90 to 3.30 morphine milligram equivalents (MME) (p < 0.001) and mobilization rates on postoperative day 1 improved from 65.3% to 81.4% (p = 0.048).

Conclusions: ERAS protocols implementation in cardiac surgery at CHUV resulted in reduced hospital length of stay, decreased opioid use, improved early mobilization, and a lower overall complication rate. These findings demonstrate the effectiveness of adapting international ERAS guidelines to local practices in cardiac surgery.

Keywords: ERAS protocols; cardiac surgery; enhanced recovery; hospital length of stay; opioid reduction; perioperative care.