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

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

Keywords

  • bundled health care
  • cardiac surgical pathways
  • enhanced recovery after surgery
  • perioperative medicine
  • quality improvement

ASJC Scopus subject areas

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

Cite this

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

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.
@article{872c20c68e7b4d898ea7e52ba654a5f4,
title = "Results from an enhanced recovery program for cardiac surgery",
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.",
keywords = "bundled health care, cardiac surgical pathways, enhanced recovery after surgery, perioperative medicine, quality improvement",
author = "{Johns Hopkins Enhanced Recovery Program for the Cardiac Surgery Working Group} and Grant, {Michael C.} and Tetsuro Isada and P. Ruzankin and Glenn Whitman and Jennifer Lawton and Dodd-o, {Jeffrey M} and Viachaslau Barodka and Stephanie Ibekwe and Mihocsa, {Andreas Bauer} and Allan Gottschalk and Cecillia Liu and Kaushik Mandal",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jtcvs.2019.05.035",
language = "English (US)",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",

}

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, Glenn

AU - Lawton, Jennifer

AU - Dodd-o, Jeffrey M

AU - Barodka, Viachaslau

AU - Ibekwe, Stephanie

AU - Mihocsa, Andreas Bauer

AU - Gottschalk, Allan

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.

KW - bundled health care

KW - cardiac surgical pathways

KW - enhanced recovery after surgery

KW - perioperative medicine

KW - quality improvement

UR - http://www.scopus.com/inward/record.url?scp=85068250522&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068250522&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.05.035

DO - 10.1016/j.jtcvs.2019.05.035

M3 - Article

C2 - 31279510

AN - SCOPUS:85068250522

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

ER -