Objective
To evaluate whether enhanced recovery after surgery (ERAS) was associated with reduced
length of stay (LOS) after urgent or emergency coronary artery bypass graft surgery
(CABG).
Design
A retrospective analysis of an institutional database for urgent or emergency isolated
CABG before versus after ERAS. Propensity matching identified comparable subpopulations
pre- versus post-ERAS. Interrupted time series analysis was used to evaluate LOS.
Setting
At a tertiary care teaching hospital.
Participants
A total of 1,012 patients undergoing urgent or emergent CABG—346 from 2016 to 2017
(pre-ERAS), and 666 from 2018 to 2020 (post-ERAS). Emergent CABG was performed within
24 hours, and urgent CABG was performed during the same hospitalization to reduce
clinical risk.
Interventions
None.
Measurements and Main Results
Propensity-matched post-ERAS (n = 565) versus pre-ERAS patients (n = 330) demonstrated
reduced LOS (9 [8-13] v (10 [8-14] days p = 0.015), increased likelihood of extubation within 6 hours (46.0% v 35.8%, p = 0.003), shorter ventilation time (6.3 [5.1-10.2] v (7.2 [5.4-12.2] hours, p = 0.003), reduced morphine milligram equivalent use on postoperative days 1 and 2 (69.6
± 62.2 v 99.0 ± 61.6, p < 0.001), and increased intraoperative ketamine use (58.8% v 35.2%, p < 0.001). There were no differences regarding reintubation, intensive care unit readmission,
or 30-day morbidity. Adjusted segmental regression (n = 1,012) for LOS demonstrated
reduced mean LOS of approximately 2 days after ERAS (β2 coefficient -1.943 [-3.766 to -0.121], p = 0.037), with stable trends for mean LOS and no change in slope throughout the pre-ERAS
and post-ERAS time periods.
Conclusions
Enhanced recovery after surgery was associated with reduced LOS after urgent or emergency
CABG without adverse effects on prolonged ventilation, reintubation, intensive care
unit readmission, or 30-day outcomes.
Key Words
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Article info
Publication history
Published online: October 13, 2022
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