Adherence to the Enhanced Recovery After Surgery in Cardiac Surgery Patients: A Randomized Clinical Trial

Abstract

Background: Improving patients' outcomes using enhanced recovery after surgery (ERAS) during the surgical period has significant economic savings and increases organizational productivity. We evaluated the effects of ERAS protocol on outcomes including high sensitive-C-reactive protein (hs-CRP), hospitalization, intensive care unit (ICU) stay, feeding tolerance and pain score of cardiac surgical patients. Methods: A total of 260 patients were randomly assigned to the ERAS and control groups according to stratified block randomization. Fasting time in the ERAS group reduced from the conventional 12 h to 6 h with light meals. Also, on the day of the operation, 2 hours before the surgery, they received 250 mL of oral carbohydrate solution containing 25 g glucose. The control group received conventional standard care. Serum hs-CRP was measured before and after the operation. Results: Out of 260 participants, 107 patients received protocolized care (ERAS group), and 103 patients received conventional standard care. Recommendations to follow the ERAS resulted in a significant reduction in hs-CRP relative to the control group (p = 0.001). Complaints about thirst, hunger, anxiety, and pain were significantly less in the intervention group than the control group (All p-values = 0.001). In addition, the length of hospitalization, ICU stay, ventilation time, and first mobility were significantly shorter in the ERAS group (All p-values = 0.001). Besides, the first postoperative meal started earlier in the intervention group than the control group (p = 0.001). Conclusion: ERAS approach can lead to improvement in postoperative inflammation, thirst, hunger, anxiety, pain, duration of hospitalization, duration of ICU stay, first mobility, and ventilation time.