Objectives
To evaluate whether enhanced recovery after surgery (ERAS) protocol implementation
was associated with improved outcomes and decreased racial and ethnic outcome disparities
after isolated coronary artery bypass graft (CABG) surgery.
Design
A retrospective analysis of an institutional CABG database with propensity-score matching.
Setting
At a single tertiary care teaching hospital.
Participants
One thousand seven hundred thirty-five patients undergoing isolated CABG: 656 patients
from 2016 to 2017 (pre-ERAS) and 1,079 patients from 2018 to 2020 (post-ERAS). Each
patient cohort was divided into a White subgroup and a racial and ethnic minorities
(Minorities) subgroup.
Interventions
None
Measurements and Main Results
Propensity-matched post-ERAS patients (n = 584) compared to pre-ERAS patients (n = 584)
demonstrated reductions in total length of stay (LOS) (median [interquartile range]):
(7 [5-10] v 8 [6-11.5] days, p = .006), postoperative LOS (5 [4-7] v 5 [4-7] days, p = .001), total ventilation time (6.1 [4.8-9.5] v 6.6 [5.2-10.9] hours, p = .004), postoperative morphine milligram equivalents (mean ± standard deviation: 68.6
± 57.5 v 100.0 ± 59.4, p < .001), and increased likelihood of early extubation (48.8% v 42.3%, p = .026); the Minorities subgroup demonstrated reductions in likelihood of intensive care
unit (ICU) readmission (1.3% v 8.1%, p = .012) and postoperative morphine milligram equivalents (73.6 ± 64.0 v 107.8 ± 71.9, p < .001). Logistic regression models demonstrated that disparities in ICU readmission
and postoperative LOS between White and Minorities patients were eliminated post-ERAS.
Conclusions
ERAS for isolated CABG surgery was associated with reduced total and postoperative
LOS, reduced total ventilation time, and increased early extubation for all patients,
as well as reduced ICU readmission for the Minorities subgroup. ERAS implementation
was associated with reduced disparities between White and racial and ethnic minority
patients for ICU readmission and postoperative LOS.
Key Words
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Article info
Publication history
Published online: February 24, 2022
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