• Jill Damstra, Bart F Geerts, Steffen Rex, VlaarAlexander P JAPJDepartment of Intensive Care, Amsterdam UMC, Location AMC, the Netherlands., DriessenAntoine H GAHGDepartment of Cardiothoracic Surgery, Amsterdam UMC, location AMC, the Netherlands., Daniel T Engelman, KlautzRobert J MRJMDepartment of Cardiothoracic Surgery, Amsterdam UMC, location AMC, the Netherlands., and Susanne Eberl.
• Department of Anesthesiology, Amsterdam University Medical Center (UMC), Location AMC, the Netherlands. Electronic address: j.damstra@amsterdamumc.nl.
• J. Cardiothorac. Vasc. Anesth. 2022 Jan 1; 36 (1): 109-117.

ObjectiveThe aim of this survey was to describe existing perioperative care standards and best practices in the Netherlands and Belgium.DesignAn online survey was followed up by an in-depth personal interview. The main outcomes were the existing standards of perioperative care for patients undergoing cardiac surgery.SettingThe online survey and subsequent interviews were targeted to one representative in the intensive care unit (ICU), cardiac surgery, and anesthesiology department from each cardiac surgical center in the Netherlands and Belgium.ParticipantsA representative intensive care physician, cardiac surgeon, and cardiac anesthesiologist.InterventionsNone.Measurements And Main ResultsThe response rate was 60% (71% for the Netherlands, and 44% in Belgium). Agreement across centers was found for discontinuation of proton-pump inhibitors (80%) and avoiding intra- and postoperative (92%) nonsteroidal antiinflammatory drugs. Additionally, 98% of respondents stated that physiotherapy should be started immediately in the ICU. Major divergence was found for elements such as the discontinuation of angiotensin-converting enzyme inhibitors (55%) or the postoperative use of chest support vests (44%).ConclusionsThe authors demonstrated a wide range of different local protocols. Strategies differed among disciplines, hospitals, and countries. This emphasized the need for the implementation of a more universal protocol to further reduce variance and improve recovery practices. This nationwide survey was the first of its kind simultaneously studying best practices for cardiac surgery through the entire care pathway at the advent of Enhanced Recovery After Surgery (ERAS) Cardiac implementation. A multinational randomized controlled trial to test the implementation of an evidence-based ERAS Cardiac protocol is the next step to pave the way for further outcome improvements in this high-risk population.Copyright © 2021 Elsevier Inc. All rights reserved.

16 keywords...

hide…