Effect of postoperative enhanced recovery program care compared to conventional care following aortic valve replacement

BACKGROUND An enhanced recovery program (ERP) after cardiac surgery is a multidisciplinary care program aimed at reducing postoperative stress response, accelerating organ function recovery, and decreasing hospital length of stay (LOS). While ERP in cardiac surgery has shown promise, high-quality evidence remains limited. OBJECTIVE This study evaluates the impact of a postanaesthesia care unit (PACU) care (including postoperative ERP interventions) vs. conventional intensive care unit (ICU) care in patients undergoing aortic valve replacement (AVR) on hospital LOS. DESIGN Retrospective cohort study with a Cox proportional hazards regression analysis, adjusting for BMI, EuroSCORE II and surgical access. SETTING Single academic medical centre. PARTICIPANTS Patients undergoing AVR with EuroSCORE II =3 and BMI <40, admitted postoperatively to either the PACU or ICU between 2011 and 2020. INTERVENTION While pre-operative and intra-operative management were identical, postoperative care was protocolised in the PACU based on the Enhanced Recovery after Cardiac Surgery (ERAS Cardiac) pathway. MEASUREMENTS AND MAIN RESULTS A total of 751 patients were included (345 receiving PACU care and 406 ICU care). The median hospital LOS (95% CI) was significantly shorter in the PACU care group (7 [6 to 9] vs. 9 [7 to 11] days, P < 0.0001) compared to ICU patients. PACU patients had a higher likelihood of early discharge [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.46 to 1.92; P < 0.0001] and earlier removal of catheters, tube and drains, with similar reintervention (PACU vs. ICU: 4% vs. 5%, P = 0.39) and mortality rates (1% in both, P = 0.51). CONCLUSION Compared with conventional ICU, PACU-ERP care was associated with a significant reduction in hospital LOS in low-risk patients undergoing AVR. These findings suggest integrating the postoperative elements of ERAS Cardiac as a standard of care. Nevertheless, further prospective studies are needed for validation.