Results from an enhanced recovery program for cardiac surgery

Johns Hopkins Enhanced Recovery Program for the Cardiac Surgery Working Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Enhanced recovery programs are multidisciplinary perioperative bundles of evidence-based process measures. Following the design and implementation of preanesthesia and intraoperative enhanced recovery programs for cardiac surgery guidelines, we evaluated the association between compliance and key clinical outcomes. Methods: Consecutive patients undergoing cardiac surgery at a single tertiary medical center from September 2017 to June 2018 were included. Patients were stratified into low (0-4 measures) and high (5-7 measures) compliance groups and then 1-to-3 propensity matched on the basis of 15 patient and surgical covariables. The primary outcome of interest was time to postoperative extubation. Secondary outcomes included interval time point extubation rates and intensive care unit, floor, and hospital lengths of stay. Results: A total of 451 patients were included in the study. After propensity matching (n = 315), patients in the high compliance group (n = 84) had a significant reduction in time to extubation (P < .001), floor length of stay (P = .01), and hospital length of stay (P = .03) compared with patients in the low compliance group (n = 231). Patients in the high compliance group were more likely to be extubated in the operating room (odds ratio, 35.8; 95% confidence interval, 10.66-168.75; P < .001) and within 6 hours of surgery (odds ratio, 2.6; 95% confidence interval, 1.18-6.07; P < .02). High compliance was associated with a median estimated time reduction of 3.4 hours to postoperative extubation (P < .001) and 19.4 hours in hospital length of stay (P = .01) compared with low compliance counterparts. There were no reintubations reported among patients extubated in the operating room (0/62 patients). Conclusions: There is value in developing phase-specific enhanced recovery programs guidelines, which improve rates of early extubation and affect the duration of stay after cardiac surgery. These results are hypothesis generating, and further prospective study is necessary to identify clinical impact of further program expansion.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Thoracic Surgery
Compliance
Length of Stay
Operating Rooms
Odds Ratio
Guidelines
Confidence Intervals
Process Assessment (Health Care)
Intensive Care Units
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Johns Hopkins Enhanced Recovery Program for the Cardiac Surgery Working Group. / Results from an enhanced recovery program for cardiac surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2019.
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abstract = "Objective: Enhanced recovery programs are multidisciplinary perioperative bundles of evidence-based process measures. Following the design and implementation of preanesthesia and intraoperative enhanced recovery programs for cardiac surgery guidelines, we evaluated the association between compliance and key clinical outcomes. Methods: Consecutive patients undergoing cardiac surgery at a single tertiary medical center from September 2017 to June 2018 were included. Patients were stratified into low (0-4 measures) and high (5-7 measures) compliance groups and then 1-to-3 propensity matched on the basis of 15 patient and surgical covariables. The primary outcome of interest was time to postoperative extubation. Secondary outcomes included interval time point extubation rates and intensive care unit, floor, and hospital lengths of stay. Results: A total of 451 patients were included in the study. After propensity matching (n = 315), patients in the high compliance group (n = 84) had a significant reduction in time to extubation (P < .001), floor length of stay (P = .01), and hospital length of stay (P = .03) compared with patients in the low compliance group (n = 231). Patients in the high compliance group were more likely to be extubated in the operating room (odds ratio, 35.8; 95{\%} confidence interval, 10.66-168.75; P < .001) and within 6 hours of surgery (odds ratio, 2.6; 95{\%} confidence interval, 1.18-6.07; P < .02). High compliance was associated with a median estimated time reduction of 3.4 hours to postoperative extubation (P < .001) and 19.4 hours in hospital length of stay (P = .01) compared with low compliance counterparts. There were no reintubations reported among patients extubated in the operating room (0/62 patients). Conclusions: There is value in developing phase-specific enhanced recovery programs guidelines, which improve rates of early extubation and affect the duration of stay after cardiac surgery. These results are hypothesis generating, and further prospective study is necessary to identify clinical impact of further program expansion.",
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Results from an enhanced recovery program for cardiac surgery. / Johns Hopkins Enhanced Recovery Program for the Cardiac Surgery Working Group.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Results from an enhanced recovery program for cardiac surgery

AU - Johns Hopkins Enhanced Recovery Program for the Cardiac Surgery Working Group

AU - Grant, Michael C.

AU - Isada, Tetsuro

AU - Ruzankin, P.

AU - Whitman, G.

AU - Lawton, Jennifer S.

AU - Dodd-o, Jeffrey

AU - Barodka, Viachaslau

AU - Ibekwe, Stephanie

AU - Mihocsa, Andreas Bauer

AU - Gottschalk, A.

AU - Liu, Cecillia

AU - Mandal, Kaushik

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Enhanced recovery programs are multidisciplinary perioperative bundles of evidence-based process measures. Following the design and implementation of preanesthesia and intraoperative enhanced recovery programs for cardiac surgery guidelines, we evaluated the association between compliance and key clinical outcomes. Methods: Consecutive patients undergoing cardiac surgery at a single tertiary medical center from September 2017 to June 2018 were included. Patients were stratified into low (0-4 measures) and high (5-7 measures) compliance groups and then 1-to-3 propensity matched on the basis of 15 patient and surgical covariables. The primary outcome of interest was time to postoperative extubation. Secondary outcomes included interval time point extubation rates and intensive care unit, floor, and hospital lengths of stay. Results: A total of 451 patients were included in the study. After propensity matching (n = 315), patients in the high compliance group (n = 84) had a significant reduction in time to extubation (P < .001), floor length of stay (P = .01), and hospital length of stay (P = .03) compared with patients in the low compliance group (n = 231). Patients in the high compliance group were more likely to be extubated in the operating room (odds ratio, 35.8; 95% confidence interval, 10.66-168.75; P < .001) and within 6 hours of surgery (odds ratio, 2.6; 95% confidence interval, 1.18-6.07; P < .02). High compliance was associated with a median estimated time reduction of 3.4 hours to postoperative extubation (P < .001) and 19.4 hours in hospital length of stay (P = .01) compared with low compliance counterparts. There were no reintubations reported among patients extubated in the operating room (0/62 patients). Conclusions: There is value in developing phase-specific enhanced recovery programs guidelines, which improve rates of early extubation and affect the duration of stay after cardiac surgery. These results are hypothesis generating, and further prospective study is necessary to identify clinical impact of further program expansion.

AB - Objective: Enhanced recovery programs are multidisciplinary perioperative bundles of evidence-based process measures. Following the design and implementation of preanesthesia and intraoperative enhanced recovery programs for cardiac surgery guidelines, we evaluated the association between compliance and key clinical outcomes. Methods: Consecutive patients undergoing cardiac surgery at a single tertiary medical center from September 2017 to June 2018 were included. Patients were stratified into low (0-4 measures) and high (5-7 measures) compliance groups and then 1-to-3 propensity matched on the basis of 15 patient and surgical covariables. The primary outcome of interest was time to postoperative extubation. Secondary outcomes included interval time point extubation rates and intensive care unit, floor, and hospital lengths of stay. Results: A total of 451 patients were included in the study. After propensity matching (n = 315), patients in the high compliance group (n = 84) had a significant reduction in time to extubation (P < .001), floor length of stay (P = .01), and hospital length of stay (P = .03) compared with patients in the low compliance group (n = 231). Patients in the high compliance group were more likely to be extubated in the operating room (odds ratio, 35.8; 95% confidence interval, 10.66-168.75; P < .001) and within 6 hours of surgery (odds ratio, 2.6; 95% confidence interval, 1.18-6.07; P < .02). High compliance was associated with a median estimated time reduction of 3.4 hours to postoperative extubation (P < .001) and 19.4 hours in hospital length of stay (P = .01) compared with low compliance counterparts. There were no reintubations reported among patients extubated in the operating room (0/62 patients). Conclusions: There is value in developing phase-specific enhanced recovery programs guidelines, which improve rates of early extubation and affect the duration of stay after cardiac surgery. These results are hypothesis generating, and further prospective study is necessary to identify clinical impact of further program expansion.

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