Successful implementation of enhanced recovery after surgery (ERAS) in paediatric cardiac surgery in Australia

Abstract

Background: Enhanced Recovery After Surgery (ERAS) is a multidisciplinary evidence-based care pathway for surgical patients aimed at expediting post operative recovery without increasing risk. ERAS protocols have only been variably implemented in paediatric cardiac surgery. We introduced an ERAS protocol in our hospital in October 2019 for the first time in Australia. Methods: Prospective perioperative data was collected on all patients enrolled in the ERAS pathway between October 2019 and February 2023. The ERAS protocol included a 2-6-hour period of stay in the ICU before transfer to the ward on the same day. Prior to ERAS, patients were never transferred to the ward on the day of surgery. Results: Of 1860 patients who underwent cardiac surgery during the study period, there were 100 patients (5.38%) who were managed using the ERAS pathway. Procedures included atrial septal defect (n= 48, 48%), vascular ring (n=14, 14%), and ventricular septal defects (n=11, 11%). Median age at surgery was 4.8 years (IQR 2.8-9.4). 61 procedures (61%) were performed through a partial sternal split. Cardiopulmonary bypass (CPB) was used in 83 (83%) patients [median duration 41 minutes (IQR 29-53)]. Median myocardial ischemia time was 25 minutes (IQR 13-34). 92 (92%) patients were extubated in the operating theatre. For remaining 8 patients, the median duration of ventilation in ICU was 1.95 hours (IQR 0.86-2.79). Median length of stay in ICU was 4.4 hours (IQR 3.8-5.3). Median hospital stay was 4 days (IQR 4-5). 84 (84%) patients were transferred to the ward on the day of surgery. The other 16 (16%) patients were deemed non-compliant with the ERAS pathway [medical issues (n=8, 50%), ward bed unavailability (n=6, 37.5%), miscommunication (n=2, 12.5%)]. No patient required readmission to the ICU within 24 hours of ICU discharge. Conclusion: ERAS can be safely implemented after paediatric cardiac surgery for selected procedures. It reduces the length of stay in ICU and is an important tool for resource optimisation in paediatric cardiac surgical units in Australia.