Enhanced Recovery after Cardiac Surgery 2.0—ERAS Meets SDS

Background: With the implementation of Enhanced Recovery after Surgery (ERAS) in cardiac surgery, a multidisciplinary treatment approach in the form of the ERAS protocol has been introduced into the clinical routine of cardiac surgery. The implementation of Same Day Surgery (SDS) is a novel and innovative addition to the ERAS protocol. Therefore, the aim of this study was to analyze the clinical and economic impact of ERAS and SDS in valve surgery.

Methods: The ERAS protocol with preoperative appointments and dedicated prehabilitation was applied to a total of 93 patients from June 2023 to July 2024. Of these ERAS patients, 47 were treated with the innovative SDS concept with admission on the day of surgery (SDS group). During the same period, 47 patients underwent standard surgery and served as the control group.

Results: Mean age (ERAS/SDS: 59.8 ± 6.9 versus control: 61.8 ± 9.4; p = 0.160) and perioperative risk score (STS score: ERAS/SDS: 0.92 ± 0.5 versus control: 1.2 ± 1.0; p = 0.170) were similar in both groups. ERAS high-risk procedures (e.g., root surgery, Ross procedure, combined valve procedures) were performed in 35% of the ERAS group, 29% of the SDS group, and 39% of the control group. Redo surgeries were performed in 3/47 in the SDS group and 6/47 in the control group. Extubation in the OR was possible in 29% of the ERAS group and 38% of the SDS group. The control group was not extubated in the operating theater. The ICU stay was significantly shorter in the ERAS (33.2 ± 33.1 hours) and SDS (28.3 ± 21.3 hours) groups compared with the control group (75.5 ± 69.3 hours) (p < 0.001). Postoperative hospital stay was significantly shorter in the ERAS (8.1 ± 3.6 days) and SDS (7.4 ± 3.0 days) groups compared with the control group (9.9 ± 5.4 days) (p < 0.001). Total hospital stay was even shorter in the SDS group (8.4 ± 3.0 days) compared with the other groups (ERAS: 10.3 ± 3.8 days; control: 13.9 ± 6.0 days) (p < 0.001).

Conclusion: The incorporation of same-day surgery into the ERAS protocol can be safely and effectively implemented, with an additional reduction in the length of hospital stay. This results in enhanced patient satisfaction and economic benefits in periods of constrained hospital capacity.

Publication History

Article published online:
11 February 2025