What is Cardiac ERAS?

Cardiac Enhanced Recovery After Surgery (ERAS) is an evidence-based patient-centered program adopted elsewhere in Canada and internationally to address these challenges and improve patient outcomes.1-7 ERAS recommendations comprise a series of interventions designed to optimize patient care through the peri-operative phases.6,8 ERAS benefits include lower post-operative complications, length of stay, and cost of care, and improved satisfaction.2-7,9

Why Cardiac ERAS in Saskatchewan?

More than 800 patients undergo major cardiac surgeries each year in Saskatchewan hospitals. With the advent of the COVID-19 pandemic and resulting slowdown in surgical volumes,10 the proportion of patients waiting more than 3 months for coronary artery bypass graft surgery and cardiac valve surgery has increased to 36.7%, and 46.2% respectively.11 As wait times increase, patients are exposed to risks of worsening symptoms, hospitalization, and increased morbidity and mortality.12-15 Targeted efforts will be required to address extended wait times and pressures on health systems for personnel and resources.  

What is our Cardiac ERAS team doing?

We have developed a series of knowledge translation tools, tailored for each of our stakeholder groups including cardiac surgeons, anesthesiologists, intensivists, cardiologists, nurses, and all other healthcare providers involved in the care of cardiac surgical patients, including endocrinologists, hematologists, perfusionists, physical therapists, nutritionists and pharmacists and patients and patient families. By providing evidence for ERAS and explaining its applicability in the Saskatchewan context, we hope to overcome knowledge gaps and transcend silos potentially posing a barrier to change. 

We are currently conducting a study to implement and evaluate a Cardiac ERAS program in the Saskatchewan Health Authority to improve the access, experience, and outcomes for cardiac surgical patients while addressing increased pressures on the health system exacerbated by COVID-19.

References'

  1. Salenger R, Morton-Bailey V, Grant M, Gregory A, Williams JB, Engelman DT. Cardiac Enhanced Recovery After Surgery: A Guide to Team Building and Successful Implementation. Semin Thorac Cardiovasc Surg. 2020;32(2):187-196. doi:10.1053/j.semtcvs.2020.02.029 

  2. Gregory AJ, Grant MC, Boyle E, et al. Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes. J Cardiothorac Vasc Anesth. 2020;34(12):3218-3224. doi:10.1053/j.jvca.2020.08.007 

  3. Fleming IO, Garratt C, Guha R, et al. Aggregation of Marginal Gains in Cardiac Surgery: Feasibility of a Perioperative Care Bundle for Enhanced Recovery in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth. 2016;30(3):665-670. doi:10.1053/j.jvca.2016.01.017 

  4. Grant MC, Isada T, Ruzankin P, et al. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg. 2020;159(4):1393-1402.e7. doi:10.1016/j.jtcvs.2019.05.035 

  5. Li M, Zhang J, Gan TJ, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: A randomized clinical trial. Eur J Cardio-thoracic Surg. 2018;54(3):491-497. doi:10.1093/ejcts/ezy100 

  6. Williams JB, McConnell G, Allender JE, et al. One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg. 2019;157(5):1881-1888. doi:10.1016/j.jtcvs.2018.10.164 

  7. Zaouter C, Oses P, Assatourian S, Labrousse L, Rémy A, Ouattara A. Reduced Length of Hospital Stay for Cardiac Surgery—Implementing an Optimized Perioperative Pathway: Prospective Evaluation of an Enhanced Recovery After Surgery Program Designed for Mini-Invasive Aortic Valve Replacement. J Cardiothorac Vasc Anesth. 2019;33(11):3010-3019. doi:10.1053/j.jvca.2019.05.006 

  8. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations. JAMA Surg. 2019;154(8):755-766. doi:10.1001/jamasurg.2019.1153 

  9. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery a review. JAMA Surg. 2017;152(3):292-298. doi:10.1001/jamasurg.2016.4952 

  10. Surgical Information System. Surgical Patient Information Management Saskatchewan Health Authority. Accessed June 15, 2021. http://www.sasksurgery.ca/provider/sis.html 

  11. Specialist Directory - Saskatchewan Surgeons - Health - Government of Saskatchewan. Accessed June 15, 2021. http://specialists.health.gov.sk.ca/ 

  12. Al-Omary MS, Williams T, Brienesse SC, et al. Impact of Delay in Surgery on Outcome in Patients Undergoing Cardiac Revascularisation Surgery. Hear Lung Circ. 2021;30(6):888-895. doi:10.1016/j.hlc.2020.09.935 

  13. Légaré JF, Li D, Buth KJ. How established wait time benchmarks significantly underestimate total wait times for cardiac surgery. Can J Cardiol. 2010;26(1). doi:10.1016/S0828-282X(10)70337-8 

  14. Graham MM, Knudtson ML, O’Neill BJ, Ross DB. Treating the right patient at the right time: Access to cardiac catheterization, percutaneous coronary intervention and cardiac surgery. Can J Cardiol. 2006;22(8):679-683. doi:10.1016/S0828-282X(06)70936-9 

  15. Head SJ, da Costa BR, Beumer B, et al. Adverse events while awaiting myocardial revascularization: A systematic review and meta-analysis. Eur J Cardio-thoracic Surg. 2017;52(2):206-217. doi:10.1093/ejcts/ezx115 

Our primary objective is to educate Saskatchewan cardiac surgery patients, team members and decision makers about the concepts, principles, and benefits of enhanced recovery after surgery (ERAS) programs. We will deploy a targeted educational campaign for patients, health care providers, and decision makers in the Saskatchewan Health Authority about the evidence-based Cardiac Enhanced Recovery Recommendations to overcome barriers to adoption such as resistance to change and gaps in knowledge.