Enhanced Recovery After Surgery (ERAS) has been growing dramatically for many case types in many surgical specialties. While use has lagged in Cardiac Surgery, results from WakeMed detailed in a recent Modern Healthcare article show impressive results for these cases as well. Beginning in 2017, WakeMed pioneered enhanced recovery protocols for CV surgery with impressive results. The protocol has reduced the total time in the ICU from 45 to 28 hours, ICU readmission decreased 30% and opioid use decreased by 40%.
Their approach is multi-factorial, led by CV surgeon Judson Williams, MD. He feels that Cardiac Surgical departments have been slow to adopt enhanced recovery protocols because as he is quoted in the Modern Healthcare article “The historical mindset around cardiac surgery was that the operations were so big and the patients were so complex that all of these enhanced recovery pathways were really too difficult to apply to cardiac surgery.”
Despite this prevailing mindset, Dr. Williams realized that 80% of the morbidity for CV surgery patients was pre or postoperative, therefore he felt that ERAS protocols would improve patient outcomes. The protocol his team designed includes carbohydrate loading 2-4 hours preoperatively, around the clock multi-modal analgesia, smoking and alcohol cessation, early extubation and early mobilization.