Effectiveness of an Enhanced Recovery After Surgery Protocol in Patients Undergoing On-pump Cardiac Surgery

Primary objective: Estimate the effect of implementation of an ERP (including the use of a checklist and teaching of caretakers) on the time needed for patient extubation after on-pump cardiac surgery.

Secondary objective: Estimate the effect of implementation of a ERP (including the use of a checklist and teaching of caretakers) on the need for reintubation, the need to return to the operating room for hemostasis, on pain scores, opioid consumption and related side effects, on the incidence of postoperative delirium in the intensive care unit, on intensive care unit and hospital discharge times, on postoperative complications (stroke, acute renal failure, postoperative atrial fibrillation), and on in-hospital mortality, 30-day mortality and hospital readmission.

The hypothesis of the study is that implementation of an ERP (including the use of a checklist and teaching of caretakers) in patients undergoing on-pump cardiac surgery improves postoperative recovery through shorter extubation time and a reduction of postoperative complications.

Design of the study: single center, bidirectional (prospective and retrospective) chronological cohort study. The adherence to ERP interventions will be measured.

Prospective data will be collected in eligible patients after implementation of a cardiac ERP and compared retrospectively with eligible patients who had surgery in the year before (but not in the four weeks preceding) implementation of the cardiac ERP. In these patients, prospective data is already collected in a quality of care database in cardiac surgery.

The cardiac ERP will be implemented using a checklist designed by cardiac surgeons, anesthesiologists and intensive care specialists. The checklist is based on official ERAS recommendations and other interventions suggested in further studies on ERAS after cardiac surgery. Professionals involved in the perioperative care of cardiac surgery patients will receive specific ERP teachings three weeks and one week before the official implementation of the cardiac ERP. Posters detailing the cardiac ERP will be clearly visible in the cardiac operating rooms and next to the intensive care unit beds to promote adherence.

• Incidence of reintubation [Срок оценки: Up to 24 hours after extubation]
• Acute pain scores using the Numerical Rating Scale (NRS) [Срок оценки: 8, 16, 24 and 48 hours after surgery]
• Opioid consumption [Срок оценки: 8, 16, 24 and 48 hours after surgery]
• Opioid side effects [Срок оценки: 8, 16, 24 and 48 hours after surgery]
• Incidence of delirium in the intensive care unit (ICU) using the ICDSC score [Срок оценки: Up to 7 days after surgery or ICU discharge, whichever comes first]
• Postoperative complications [Срок оценки: Up to 7 days after surgery]
• ICU discharge time [Срок оценки: At ICU discharge, an average of one day after surgery]
• Hospital discharge [Срок оценки: At hospital discharge, an average of one week after surgery]
• In-hospital mortality [Срок оценки: At hospital discharge, an average of one week after surgery]
• 30-day mortality [Срок оценки: Up to 30 days after surgery]
• Hospital readmission [Срок оценки: Up to 30 days after surgery]