Enhanced recovery programs are perioperative bundles of evidence-based process measures that are multidisciplinary. Researchers looked at the relationship between compliance and important clinical outcomes after designing and implementing anesthesia and intraoperative improved recovery programs for cardiac surgery guidelines. From September 2017 to June 2018, patients who underwent cardiac surgery at a single tertiary medical center were included in the study. Based on 15 patient and surgical covariables, patients were classified into low (0-4 measurements) and high (5-7 measures) compliance groups, and then 1-to-3 propensity-matched. The time to postoperative extubation was the major outcome of interest. As they dive care unit, floor, and hospital duration of stay, interval time point extubation rates were secondary outcomes.
The study enlisted the participation of 451 patients. Patients in the high compliance group (n=84) had a significantly shorter time to extubation (P < .001), floor-length of stay (P=.01), and hospital length of stay (P=.03) than patients in the poor compliance group (n=231) after propensity matching (n=315). Extubation in the operating theatre (odds ratio, 35.8; 95% CI range, 10.66-168.75; P<.001) and within 6 hours of surgery (odds ratio, 2.6; 95% CI, 1.18-6.07; P < .02) were more probable in the high compliance group. When compared to poor compliance peers, high compliance was linked with a median estimated time reduction of 3.4 hours until postoperative extubation (P < .001) and 19.4 hours in hospital length of stay (P=.01). There were no reintubations among the 62 patients who were extubated in the operating room. Developing phase-specific enhanced recovery program guidelines, which improve early extubation rates and impact the length of stay following heart surgery, could be beneficial. These findings are hypothesis-generating, and further prospective research is needed to determine the clinical benefit of program extension.
Reference:www.jtcvs.org/article/S0022-5223(19)31136-5/fulltext
