Enhanced recovery after cardiac surgery and its impact on outcomes: A systematic review

Perfusion ◽

10.1177/0267659121988957 ◽

2021 ◽

pp. 026765912198895

Author(s):

Yi Zhang ◽

Jun Heng Chong ◽

Amer Harky

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Enhanced Recovery ◽

Controlled Trial ◽

Postoperative Outcomes ◽

Current Evidence ◽

Long Term Outcomes ◽

Recent Emergence ◽

Cardiac Society

Background and Aim: Enhanced Recovery After Surgery (ERAS) protocols are a series of perioperative interventions well-established in improving the care and outcomes of patients. With recent emergence of studies on its implementation in cardiac surgery, this paper represents the first systematic review on current evidence of ERAS efficacy in this field. Methods: Two reviewers independently searched through Pubmed, Cochrane, Google Scholar, Web of Science, Embase and Scopus. Comparative studies with controls that described the implementation of ERAS in all types of cardiac operations from 2001 to 2020 were included. Data extracted included patient demographics, components of ERAS protocol described, types of cardiac surgery, and postoperative outcomes. Results: In the final analysis, nine studies were included, of which there were one randomized controlled trial (RCT), one quasi-experiment and seven retrospective/prospective studies. Significant improvement in hospital and ICU length of stay, as well as reduction in postoperative opioid consumption were demonstrated. No increase in postoperative complications were reported. Conclusion: ERAS in cardiac surgery has shown to be potentially safe and effective in improving certain postoperative outcomes. However, the evidence is limited by the lack of high-quality RCTs. We also found the lack of practice of class 1 recommended interventions set forth by the ERAS Cardiac Society. Furthermore, majority of studies only evaluated the immediate postoperative outcomes of patients, and not the long-term outcomes. RCTs that fully implement measures recommended by the ERAS Cardiac Society, with assessments on both immediate and long-term outcomes, are warranted.

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Oncologic and long-term outcomes of enhanced recovery after surgery in cancer surgeries — a systematic review

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02306-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Qianyun Pang ◽

Liping Duan ◽

Yan Jiang ◽

Hongliang Liu

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Current Evidence ◽

Cochrane Library ◽

Long Term Outcomes ◽

High Adherence ◽

Eras Protocol

Abstract Background Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the current evidence was conducted. Methods The Pubmed, Cochrane Library, Embase, and Web of Science databases were searched using the following key words as search terms: “ERAS” or “enhanced recovery” or “fast track”, “oncologic outcome”, “recurrence”, “metastasis”, “long-term outcomes”, “survival”, and “cancer surgery”. The articles were screened using the inclusion and exclusion criteria, and the data from the included studies were extracted and analyzed. Results A total of twenty-six articles were included in this review. Eighteen articles compared ERAS and conventional care, of which, 12 studies reported long-term overall survival (OS), and only 4 found the improvement by ERAS. Four studies reported disease-free survival (DFS), and only 1 found the improvement by ERAS. Five studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT), and 4 found improvements in the ERAS group. Seven studies compared high adherence to ERAS with low adherence, of which, 6 reported the long-term OS, and 3 showed improvements by high adherence. One study reported high adherence could reduce the interval from surgery to RIOT. Four studies reported the effect of altering one single item within the ERAS protocol, but the results of 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy. Conclusions The use of ERAS in cancer surgeries can improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence. Based on the current evidence, it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival.

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Long Term Surgical Outcomes For Infective Endocarditis In People Who Inject Drugs: A Systematic Review And Meta-Analysis

10.21203/rs.2.13953/v1 ◽

2019 ◽

Author(s):

David Goodman-Meza ◽

Robert E Weiss ◽

Sebastian Gamboa ◽

Abel Gallegos ◽

Alex AT Bui ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Infective Endocarditis ◽

People Who Inject Drugs ◽

Individual Patient Data ◽

Meta Analysis ◽

The United States ◽

Patient Data ◽

Long Term Outcomes

Abstract Background: In the United States, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID. Methods: We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID . Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival. Results: We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3%, 81.0%, 62.1%, and 56.6% in PWID, respectively; and 96.4%, 85.0%, 70.3%, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05-2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25-4.50) than non-PWID. Conclusion: PWID were younger and had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.

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Long-term outcomes of postoperative atrial fibrillation following non cardiac surgery: A systematic review and metanalysis

European Journal of Internal Medicine ◽

10.1016/j.ejim.2020.12.018 ◽

2021 ◽

Author(s):

Alessandro Albini ◽

Vincenzo Livio Malavasi ◽

Marco Vitolo ◽

Jacopo Francesco Imberti ◽

Marco Marietta ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Cardiac Surgery ◽

Postoperative Atrial Fibrillation ◽

Long Term Outcomes

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Long Term Surgical Outcomes For Infective Endocarditis In People Who Inject Drugs: A Systematic Review And Meta-Analysis

10.21203/rs.2.13953/v2 ◽

2019 ◽

Author(s):

David Goodman-Meza ◽

Robert E Weiss ◽

Sebastian Gamboa ◽

Abel Gallegos ◽

Alex AT Bui ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Infective Endocarditis ◽

People Who Inject Drugs ◽

Cox Regression ◽

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Long Term Outcomes

Abstract Background: In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID. Methods: We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID . Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival. Results: We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3%, 81.0%, 62.1%, and 56.6% in PWID, respectively; and 96.4%, 85.0%, 70.3%, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05-2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25-4.50) than non-PWID. Conclusion: PWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.

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Long term surgical outcomes for infective endocarditis in people who inject drugs: a systematic review and meta-analysis

BMC Infectious Diseases ◽

10.1186/s12879-019-4558-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 7

Author(s):

David Goodman-Meza ◽

Robert E. Weiss ◽

Sebastián Gamboa ◽

Abel Gallegos ◽

Alex A. T. Bui ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Infective Endocarditis ◽

People Who Inject Drugs ◽

Cox Regression ◽

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Long Term Outcomes

Abstract Background In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID. Methods We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival. Results We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05–2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25–4.50) than non-PWID. Conclusion PWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.

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Psychological Preparation for Cardiac Surgery

Current Cardiology Reports ◽

10.1007/s11886-020-01424-9 ◽

2020 ◽

Vol 22 (12) ◽

Author(s):

Stefan Salzmann ◽

Miriam Salzmann-Djufri ◽

Marcel Wilhelm ◽

Frank Euteneuer

Keyword(s):

Cardiac Surgery ◽

Postoperative Outcomes ◽

Psychological Status ◽

Long Term Outcomes ◽

Psychological Preparation ◽

Positive Effects ◽

Current State ◽

Short And Long Term

Abstract Purpose of Review To review the current state of preoperative psychological preparation to improve outcomes after cardiac surgery. Recent Findings Preoperative psychosocial factors are associated with short- and long-term outcomes after cardiac surgery. There are several approaches to optimize patients’ preoperative psychological status with promising effects on postoperative outcomes (e.g., less complications, improved quality of life). Preoperative psychological preparation often aims to improve patients’ knowledge or social support and to modify and optimize expectations and illness beliefs. Summary Preoperative psychological preparation is gaining importance for cardiac surgery. However, patients’ psychological status still does not get as much attention as it deserves. Preoperative psychological preparation seems to have positive effects on postoperative outcomes. Since overall evidence is still weak, further studies are warranted to understand which intervention works best for whom and why.

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