Objective
The aim of this survey was to describe existing perioperative care standards and best
practices in the Netherlands and Belgium.
Design
An online survey was followed up by an in-depth personal interview. The main outcomes
were the existing standards of perioperative care for patients undergoing cardiac
surgery.
Setting
The online survey and subsequent interviews were targeted to one representative in
the intensive care unit (ICU), cardiac surgery, and anesthesiology department from
each cardiac surgical center in the Netherlands and Belgium.
Participants
A representative intensive care physician, cardiac surgeon, and cardiac anesthesiologist.
Interventions
None.
Measurements and Main Results
The response rate was 60% (71% for the Netherlands, and 44% in Belgium). Agreement
across centers was found for discontinuation of proton-pump inhibitors (80%) and avoiding
intra- and postoperative (92%) nonsteroidal antiinflammatory drugs. Additionally,
98% of respondents stated that physiotherapy should be started immediately in the
ICU. Major divergence was found for elements such as the discontinuation of angiotensin-converting
enzyme inhibitors (55%) or the postoperative use of chest support vests (44%).
Conclusions
The authors demonstrated a wide range of different local protocols. Strategies differed
among disciplines, hospitals, and countries. This emphasized the need for the implementation
of a more universal protocol to further reduce variance and improve recovery practices.
This nationwide survey was the first of its kind simultaneously studying best practices
for cardiac surgery through the entire care pathway at the advent of Enhanced Recovery
After Surgery (ERAS) Cardiac implementation. A multinational randomized controlled
trial to test the implementation of an evidence-based ERAS Cardiac protocol is the
next step to pave the way for further outcome improvements in this high-risk population.
Key Words
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Article info
Publication history
Published online: September 04, 2021
Identification
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