An international group of leading heart surgeons, anesthesiologists and critical care specialists known as ERAS® Cardiac has published the first “Guidelines for Perioperative Care: Enhanced Recovery After Surgery Society Recommendations” in JAMA Surgery today. Development of these recommendations was endorsed by the Enhanced Recovery After Surgery (ERAS®) Society.
The landmark publication is contemporaneous with multiple ERAS sessions being presented at the American Association for Thoracic Surgery (AATS) meeting in Toronto, Canada. The ERAS Society Guideline Recommendations were developed through a two-year formal process to provide cardiac surgical programs evidence-based protocols to enhance patient recovery following heart surgery. The group’s mission is to facilitate optimization of the perioperative care of cardiac surgical patients, through collaborative discovery, analysis, expert consensus, and dissemination of best practices that will improve both short and long-term outcomes and value and decrease complications and readmissions.
Some of the standardized approaches addressed include: prehabilitation to better prepare patients for surgery; pathways to manage glucose, fluids, and temperature; antifibrinolytic and multimodal anesthesia utilization; protocols for delirium, VTE, infection prevention, early extubation, rigid fixation of the sternum, chest tube management to prevent retained blood syndrome, and the use of biomarkers and goal-directed fluid therapy to prevent acute kidney injury.
The initiative was led by Daniel T. Engelman, MD, Medical Director, Heart & Vascular Program, Baystate Health, Springfield, MA.
“We are very excited to begin standardizing evidence-based best practice for the perioperative care of all patients undergoing cardiac surgery,” said Dr. Engelman. “We were the last of the surgical specialties to publish ERAS guidelines and wish to thank our international multidisciplinary team for their dedication to this long overdue project to improve the patient-centered value.”
Other contributing authors include Richard Engelman, MD, Baystate Medical Center; Judson Williams, MD, WakeMed Health and Hospitals; Edward Boyle, MD, St. Charles Medical Center; Alexander Gregory, MD, Cumming School of Medicine, University of Calgary; Walid Ben Ali MD and Louis P. Perrault, MD, Ph.D., Montreal Heart Institute; Marjan Jahangiri, MBBS MS, St. George’s, University of London; Ali Khoynezhad, MD, PhD, MemorialCare Heart & Vascular Institute; Rakesh C. Arora, MD, St. Boniface General Hospital; Eric Roselli, MD, Cleveland Clinic; V. Seenu Reddy, MD, Centennial Heart & Vascular Center; Marc Gerdisch, MD, Franciscan Health Heart Center; Jerrold Levy, MD, Duke University; Kevin Lobdell, MD, Atrium Health; Nick Fletcher, MBBS, St George’s, University of London; Matthias Kirsch, MD, CHUV Cardiac Surgery Centre, University Hospital Vaudois; Gregg Nelson, MD, University of Calgary; and Michael Grant, MD, Johns Hopkins.
“This work was possible due to this extraordinary group of international experts who dedicated their valuable personal time away from clinical practice, families, and other commitments,” said Dr. Judson Williams, recipient of the first Center of Excellence Award and author of the first US-based ERAS Cardiac results. “This is a critical first step toward a systematic outline of evidence-based best practice, for perioperative cardiac surgical care. The next steps will be to collaboratively implement ERAS protocols, standardize the continuous audit, and set benchmarks for outcomes.”
“The ERAS® Guidelines in Cardiac Surgery represent a substantial advance in quality healthcare delivery and a starting point for ERAS® in the cardiac surgical specialty," said Professor Olle Ljungqvist, Örebro University, Sweden, Chairman of the ERAS® Society. "Following a careful review of the literature and available evidence, the authors present a stepwise process to improve outcomes. The guidelines also reveal where potential knowledge gaps exist and thus give direction for future studies. The ERAS® Society is excited to continue to support the further development of ERAS® principles and practice in cardiac surgery, working together with the ERAS® Cardiac Society to standardize evidence based-practice.”
ERAS® Cardiac is a non-profit organization with the mission to develop evidence-based expert consensus statements promoting best practice recovery practices. The goal is to provide hospitals better guidance for developing local protocols that are part of a continuous quality improvement (CQI) process for better patient care and a reduction of postoperative complications and costs after cardiothoracic surgery (www.erascardiac.org). Focusing on cardiac surgery, our organization is collaborating with ERAS® (www.erassociety.org), an organization that promotes enhanced recovery in many other surgical specialties worldwide. Contact Alex Gregory, MD:Alex.Gregory@albertahealthservices.ca
The ERAS® Society (www.erassociety.org) is an international, non-profit, multi-professional and multi-disciplinary medical society registered in Sweden devoted to the improvement of perioperative care, most commonly referred to as “Enhanced Recovery After Surgery" or "ERAS." The ERAS® Society is comprised of leaders and developers of care for patients undergoing surgery in a large range of surgical specialties. The ERAS® Study Group and later the ERAS® Society was assembled by Professor Ken Fearon, University of Edinburgh, UK and Professor Olle Ljungqvist, Karolinska Institute, Sweden in 2001.