https://doi.org/10.1007/s00392-025-02625-4
1Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Herz- und Gefäßchirurgie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Hamburg, Deutschland; 3Universitätsklinikum Augsburg Klinik für Anästhesiologie Augsburg, Deutschland
Background:
The introduction of Enhanced Recovery after Surgery (ERAS) in cardiac surgery has led to the implementation of a multidisciplinary treatment approach in the form of the ERAS protocol. The incorporation of Same Day Surgery (SDS) represents a novel and innovative addition to the ERAS protocol. The objective of this study was to analyse the clinical and economic impact of ERAS and SDS in valve surgery.
Method:
The ERAS protocol, which incorporates preoperative appointments and dedicated prehabilitation, was applied to a total of 93 patients from June 2023 to July 2024. Of the patients who underwent the ERAS protocol, 47 were treated with the innovative SDS concept, with admission on the day of surgery (SDS group). During the same period, 47 patients underwent standard surgical procedures and constituted the control group.
Results:
Mean age (ERAS/SDS: 59.8±6.9 vs. control: 61.8±9.4; p=0.160) and perioperative risk score (STS score: ERAS/SDS: 0.92±0.5 vs. control: 1.2±1.0; p=0.170) were similar in both groups. ERAS high-risk procedures (e.g. root surgery, Ross procedure, combined valve procedures) were performed in 35% of the ERAS group, 29% of the SDS group and 39% of the control group. Redo surgeries were performed in 3/47 in the SDS group and 6/47 in the control group. Extubation in the OR was possible in 29% of the ERAS group and 38% of the SDS group. The control group was not extubated in the operating theatre. The ICU stay was significantly shorter in the ERAS (33.2±33.1 hours) and SDS (28.3±21.3 hours) groups compared to the control group (75.5±69.3 hours) (p<0.001). Postoperative hospital stay was significantly shorter in the ERAS (8.1±3.6 days) and SDS (7.4±3.0 days) groups compared to the control group (9.9±5.4 days); p<0.001. Total hospital stay was even shorter in the SDS group (8.4±3.0 days) compared to the other groups (ERAS:10.3±3.8 days; control:13.9±6.0 days); p<0.001.
Conclusion:
The integration of same-day surgery into the ERAS protocol is a safe and effective approach that can result in a further reduction in the length of hospital stay. This results in an improvement in patient satisfaction and a reduction in costs during periods of constrained hospital capacity.