• David Delijani, Abigail Race, Hugh Cassiere, Joseph Pena, Linda J Shore-Lesserson, Valerie Demekhin, Frank Manetta, Xueqi Huang, Douglas A Karman, Alan Hartman, and Pey-Jen Yu.
• Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Manhasset, NY.
• J. Cardiothorac. Vasc. Anesth. 2024 Jan 1; 38 (1): 175182175-182.

ObjectivesEnhanced recovery pathway (ERP) refers to extensive multidisciplinary, evidence-based pathways used to facilitate recovery after surgery. The authors assessed the impact that limited ERP protocols had on outcomes in patients undergoing cardiac surgery at their institution.DesignA retrospective cohort study.SettingThis study was a single-institution study conducted at a university hospital.ParticipantsPatients undergoing open adult cardiac surgery.InterventionsEnhanced recovery pathways limited to preoperative, intraoperative, and postoperative management of pain, atrial fibrillation prevention, and nutrition optimization were implemented.Measurements And Main ResultsA total of 1,058 patients were included in this study. There were 374 patients in each pre- and post-ERP cohort after propensity matching, with no significant baseline differences between the 2 cohorts. Compared to the matched patients in the pre-ERP group, patients in the post-ERP group had decreased total ventilation hours (6.8 v 7.8, p = 0.006), less use of postoperative opioid analgesics as determined by total morphine milligram equivalent (32.5 v 47.5, p < 0.001), and a decreased rate of postoperative atrial fibrillation (23.3% v 30.5%, p = 0.032). Post-ERP patients also experienced less subjective pain and postoperative nausea and drowsiness as compared to their matched pre-ERP cohorts.ConclusionsLimited ERP implementation resulted in significantly improved perioperative outcomes. Patients additionally experienced less postoperative pain despite decreased opioid use. Implementation of ERP, even in a limited format, is a promising approach to improving outcomes in patients undergoing cardiac surgery.Published by Elsevier Inc.

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