(191) Enhanced Recovery After Surgery (ERAS) Versus Pre-ERAS Programs in Cardiothoracic Surgery Patients

Tuesday, February 25, 2025

8:45am – 9:45am Eastern Time

Location: Connections Central - RST 04

First Author(s)

Jessica Blair, PharmD (she/her/hers)

Cleveland Clinic - Hillcrest Hospital, USA

Co-Author(s)

WB

Weston Bush, PharmD, BCPS

Critical Care Clinical Specialist
University Hospitals Cleveland Medical Center, United States
BL

Brian Lauer, PharmD, BCCCP

Critical Care Clinical Specialist
University Hospitals Cleveland Medical Center, United States
AJ

Angela Johnson, MD

Medical Director, Cardiothoracic Surgery Intensive Care Unit
University Hospitals Cleveland Medical Center, United States
DA

Daniel Asher, MD

Medical Director, Mather PACU
University Hospitals Cleveland Medical Center, United States
BM

Basanta Mohapatra, MD

Assistant Professor, Anesthesiology
University Hospitals Cleveland Medical Center, United States
RA

Rakesh Arora, MD, FRCPC

Clinical Professor
Case Western
Cleveland, Ohio, United States

Introduction: ERAS is a multimodal, multidisciplinary, evidence-based approach to care of the surgical patient that aims to optimize perioperative management and outcomes. The purpose of this evaluation is to assess clinical and quality endpoints since the implementation of the ERAS protocol in cardiothoracic surgery patients. The primary endpoint was to compare pain regimens of patients in the perioperative phases of surgery.

Methods: This was a single-center retrospective cohort study. All tests were two-sided with p< 0.05 considered statistically significant. Expecting to see a difference of 15% in opioid use, the sample size required to meet Power (80%) was 200 patients (100 in each group).

Results: There were 100 patients analyzed in each group in this evaluation. In the pre/intraoperative phase of surgery there were more patients on acetaminophen (95% compared to 8% (p-value < 0.001), gabapentin (8% vs 1% (P= 0.035)), ketamine (18% vs 8% (P= 0.036)), dexmedetomidine (38% vs 3% (P < 0.001)), and regional pain blocks (38% vs 0 (P < 0.001)) in the post-ERAS compared to the pre-ERAS group. On POD1 patients in the post-ERAS group received significantly less opioids (44.1 (28.4) MME vs 91.9 (91.3) MME (P < 0.001)), more acetaminophen (2959.1 (890.7) mg vs 1314.3 (982.4) mg (P < 0.001)), and more gabapentin (700 (200-900) mg vs 0 (0-150) mg (P= 0.03)) when compared to the pre-ERAS group. By POD3 patients again received significantly less opioids (14.3 (24.6) MME vs 23.6 (26.6) mg (P= 0.012)). There was a significant decrease in opioids prescribed at discharge in ERAS patients compared to pre-ERAS patients (31% vs 47.4% (P=0.018)). In the post-ERAS group, there was a significant decreased ICU LOS (2.6 (3.98) days vs 4.6(7.04) days (P= 0.015)), postoperative ventilator days (0.3 (1.01) days vs 1.7 (4.96) days (P=0.006)), and time to OOB ambulation (1.6 (1.67) days vs 2.5 (1.95) days (P=0.002)).

Conclusions: Our study demonstrated that the implementation of an ERAS protocol led to an increase in a multimodal analgesic approach in the perioperative phases of surgery with an overall decrease in opioid consumption. Additionally, our study demonstrated various other clinical and quality endpoints for an ERAS protocol in cardiothoracic surgery patients.