Enhanced Recovery after Surgery: Implementation in the Preoperative and Postoperative Management of Children Undergoing Cardiac Surgery Is Low and Differs Across European Centers

Abstract

Objectives: Enhanced Recovery After Cardiac Surgery (ERACS) is a multimodal and interdisciplinary approach aimed at improving postoperative recovery. A survey was conducted to explore the degree of implementation of ERACS in pediatric cardiac surgery across Europe. The results of the intraoperative phase have been reported previously. The present study examined implementation of ERACS preoperatively and postoperatively.

Design: Prospective, 79-item, web-based cross-sectional survey.

Setting: Survey endorsed by the European Association of Cardiothoracic Anesthesiology and Intensive Care.

Participants: Lead anesthesiologists of active European pediatric cardiac surgical centers.

Interventions: None.

Measurements and main results: Responses were received and analyzed from 42 of 89 centers (43%), with 16 centers (38.1%) reporting implemented ERACS protocols for pediatric cardiac surgery. Preoperative anemia assessment is common (73.8%), but anemia treatment and preoperative transfusion practices vary. In centers following ERACS protocols fasting times are reduced particularly for clear fluids (<1 hour: 50% v 26.9%) and light meals (<4 hours: 62.5% v 26.9%). However, preoperative assessment of nutritional status is performed only rarely (42.9% overall; 18.8% in ERACS centers). Drain removal tends to occur earlier in centers following ERACS protocols (within 12 hours: 33.3% v 4.8%).

Conclusions: ERACS implementation for children undergoing cardiac surgery varies substantially among the responding centers and is overall low, particularly during the preoperative period. ERACS centers show a higher implementation of measures such as a liberal approach to preoperative fasting and early drain removal but lack in other measures, such as preoperative treatment of anemia and assessment of nutritional status. Overall, these data demonstrate a large potential for improvement in the preoperative and postoperative management of children undergoing cardiac surgery.

Keywords: ERACS; ERAS; fast track; pediatric cardiac surgery; perioperative management; postoperative recovery; preoperative evaluation.