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Published on March 12, 2020

Can you go home sooner after open heart surgery?

Home after surgery

Patients who underwent open heart surgery and headed home three days later showed no increased risks of complications compared to people who stayed in the hospital longer, according to a recent presentation at the annual meeting of The Society of Thoracic Surgeons.

Patients on Cape Cod soon will be able to take advantage of the benefits of an Enhanced Recovery After Surgery (ERAS) program.

“The ERAS initiative is one of our goals for 2020,” said Dan Loberman, MD, chief of cardiac surgery at Cape Cod Hospital.

The early-release trend began in general surgery and moved to orthopedic surgery, he said.

“ERAS is a hot topic right now in cardiac surgery, and we are just following that national trend. This year we are planning on adopting different protocols that have to do with the way we prepare patients for surgery, with the way we treat them during surgery and how we care for them in the postoperative period. We are hoping to significantly shorten their length of stay.”

The study presented at the annual meeting of The Society of Thoracic Surgeons involved ERAS programs for nonemergency coronary artery bypass grafting (CABG) surgery and valve surgery. Mortality rates and 30-day readmission rates were comparable for patients who were released after three days and those who stayed longer. The study was done between 2004 and 2017 at Northwestern Memorial Hospital in Chicago and included a total of 478 patients.

“Patients can go home after a shorter length of stay in the hospital without increased risk of complications and rehospitalizations,” Dr. S. Chris Malaisrie, MD, of Northwestern Medicine, one of the presenters, said in a press release. “Because we found no detrimental effect of accelerated discharge, both patients and physicians should not be averse to discharging patients when medically ready.”

Putting ERAS into practice at Cape Cod Hospital will entail a multilayer protocol that will involve nurses, physician assistants, anesthesiologists, perfusionists and others, Dr. Loberman said.

ERAS guidelines call for 22 preoperative, intraoperative and postoperative interventions. They include “prehabilitation” (exercise training, nutrition optimization, and anxiety reduction) before surgery and strategies for reducing opioid use and dependence after surgery.

“The basic rule for everything we do here is safety,” said Dr. Loberman. “There is no benefit in keeping a patient in a hospital longer than necessary. We want to boost their return to full activity as fast as we safely can.”

Dr. Loberman was part of a study at Brigham and Women's Hospital in Boston to devise screening practices to outline which patients best fit the ERAS protocol.

Among the measures that determine when a patient can leave the hospital for home or a rehab facility are the ability to stand, walk and climb stairs.

Daniel T. Engelman, MD, president of the ERAS Cardiac Society, recently gave a presentation to Cape Cod cardiac surgeons and staff members.

“We are ready to move ahead with some changes that will benefit many patients and their families,” said Dr. Loberman.