Evaluation of an Enhanced Recovery after Cardiac Surgery Program

Growing evidence supports an enhanced recovery after surgery (ERAS) program for numerous surgical specialties. These programs are multimodal, transdisciplinary care quality improvement (QI) initiatives to promote the recovery of patients undergoing surgery throughout their entire perioperative journey (Ljungqvist et al., 2017). Regardless of surgical specialty, all ERAS protocols share the same objectives: preoperative patient optimization, decreased perioperative stress, maintenance of post-operative physiologic function, and accelerated recovery time after surgery (Ljungqvist et al., 2017). There is increasing but limited evidence to support enhanced recovery after cardiac surgery programs (ERAS Cardiac). The ERAS Cardiac Society guidelines were published in 2019 (Engelman et al., 2019). Since the guidelines have been published, ERAS Cardiac programs varied considerably and lack standardization. Despite these limiting factors, recent evidence supports ERAS Cardiac programs demonstrate improved patient outcomes, i.e., lower pain scores, reduction in intensive care unit (ICU) and hospital length of stay (LOS), and shorter ventilation times (Fleming et al., 2016; Li et al., 2018; Williams et al., 2019; Yazdchi et al., 2022; Zaouter et al., 2019). This QI initiative aimed to evaluate an ERAS Cardiac program at a community hospital in North Carolina, which was first implemented in 2017. The ERAS Cardiac program was created to adopt ERAS principles in cardiac surgery and to reduce operative complications, including opioid use, gastrointestinal complications, LOS, and patient and staff satisfaction (Williams et al., 2019). Evaluation of such a program could benefit future patients and health systems by identifying program strengths and limitations. In addition to evaluating program elements, evaluating implementation strategies will offer further insight into future quality improvement efforts for health systems.