Inaugural Meeting on Enhanced Recovery After Cardiac Surgery

The recently-formed group Enhanced Recovery After Cardiac Surgery (ERACS) held its inaugural symposium on April 29, 2017. The session, which took place in Boston, MA, was called “ERACS: Best Practices, Cost-Effective Initiative.” It featured a consortium of forward-thinking leaders in cardiac surgery, who joined together to address the need to standardize best practices in cardiac surgery. This cardiac-specific session was inspired by other specialties' participation in Enhanced Recovery After Surgery (ERAS) programs.

The initiative was led by Daniel Engelman, MD, Interim Chief of Cardiac Surgery and Medical Director of Heart, Vascular, and Critical Care Services at Baystate Medical Center, Springfield, MA. “In an era of value-based healthcare and mandated bundles, it is essential to bring together evidenced-based approaches that can improve healthcare outcomes while controlling costs,” said Dr Daniel Engelman. “Our goal is to publish clinical guidelines and expert consensus documents to standardize best practices and improve postoperative cardiac surgical care.”

The organizing committee included Louis Perrault, MD, PhD, Chief of Cardiac Surgery at the Montreal Heart Institute (Montreal, Canada); Eric Roselli, MD, Director of the Aorta Center at Cleveland Clinic (Cleveland, OH); V. Seenu Reddy, MD, Centennial Heart & Vascular Center (Nashville, TN); Marc Gerdisch, MD, Chief of CT Surgery at St Francis Heart Center (Indianapolis, IN); and Edward Boyle, MD, St Charles Medical Center (Bend, OR).

Addressing the fact that surgeons have long sought to develop protocols to speed recovery of their patients after surgery, the symposium kicked off with a historical review by Dr Richard Engelman, who pioneered the first "fast-track" recovery pathways for cardiac surgery patients in the 1990s.

“There is a fundamental shift underway in medicine towards value, and obtaining the best possible care for the least price,” said Dr Daniel Engelman. “We are building on past successes, utilizing a multitude of new technologies and protocols that reduce complications and length of stay, and provide a better patient experience at a lower cost.”

Some of the newer approaches that were considered at the meeting included new techniques for rigid fixation of the sternum, active clearance methods to prevent retained shed mediastinal blood, use of biomarkers to prevent acute kidney injury, methods to minimize opioid use, and novel approaches to reduce postoperative atrial fibrillation and delirium.

“Past ‘fast-track’ efforts have largely focused on rapid removal from assisted ventilation and early mobilization,” added Dr Daniel Engelman. “Our goal was to look at the next level of available protocols, pharmaceuticals, and technologies that would improve long-term outcomes and decrease complications and readmissions. This highly specialized group of world class cardiac surgeons presented novel and innovative cost-effective approaches to postoperative care, ensuring that they provide the greatest value to their patients.”

ABOUT ERACS: Enhanced Recovery After Cardiac Surgery (ERACS) is a non-profit organization with the mission to develop evidence-based expert consensus statements promoting best-practice recovery practices. The goal is to provide hospitals with better guidance for developing local protocols that are part of a continuous quality improvement (CQI) process for better patient care and a reduction of postoperative complications and costs after cardiothoracic surgery. Focusing on cardiac surgery, the organization works with the broader ERAS Society, an organization that promotes enhanced recovery in many other surgical specialties worldwide. For more information about ERACS, contact: Alan Morasch, CAE via alan@eracs.org.