Enhanced Recovery After Surgery (ERAS)

Heart surgery can be frightening to patients and their caretakers. There are many unknowns to navigate. Will it be painful? How long will I have to stay in the hospital? Will my other medical conditions complicate my surgery?

At Pulse Heart Institute, we have a team of specially trained experts who work with each patient to minimize the risks. We identify and treat risk factors prior to surgery, and carefully manage each patient throughout the pre, intra and post-operative phases using Enhanced Recovery After Surgery (ERAS). ERAS was developed in the 1990’s by Professor Henrik Kehlet in Denmark, to modify physiological and psychological responses to major surgery, optimizing surgical outcomes. The use of ERAS reduces complications and length of stay – both important for heart surgery patients.

How ERAS Works

ERAS is used during all three phases of surgical care – preoperatively (before surgery), intraoperatively (during surgery) and postoperatively (after surgery).

Preoperative

Prior to heart surgery, patients receive counseling from their cardiothoracic surgeon, the physician assistants (PAs) and the surgical navigator. They discuss topics such as fluid and carbohydrate loading, antibiotic use, whether prolonged fasting is needed prior to surgery and any medications or supplements are needed preoperatively. Blood is drawn several days prior to the preoperative appointment to assess for malnutrition and patients at risk for this meet with a nutritionist during their pre-op appointment. Open heart surgery patients are also encouraged to identify a “health coach” – a family member or friend who can come to the preoperative appointments and who can help post-operatively.

Intraoperative

During the open-heart surgery, the surgical team optimizes the experience for each patient. From using short acting anesthetics, the minimal use of drains, early catheter removal and avoiding salt and water overload, many things are done to ensure each patient is managed throughout the surgery in the best way for their individual needs. These practices help each patient experience the optimal surgical outcome.

Postoperative

After surgery, the ERAS team ensures the proper steps are taken to expedite recovery. Removing catheters early and getting patients up and walking with assistance as soon as possible, preventing nausea and vomiting with the proper types of analgesia and stimulating the digestive system are all ways ERAS promotes healing in open-heart patients. Post-op discharge planning is started early as well, to decrease the length of stay in the hospital and help patients resume their normal daily activities.

Patient Experience

At Pulse, our focus is on optimizing outcomes for each individual patient. ERAS helps us do that. By reducing complications and expediting discharge from the hospital each patient can get back to life as soon as possible. It also reduces morbidity – illnesses that can occur as a result of surgical procedures – by 23-56%. Other benefits of ERAS are the accelerated return of organ function/prevention of organ decline, reduced need for daytime sleep, reduced days required for sick leave, improved muscle function and physical strength and preserved lean body mass and exercise performance.