Pre-match open aortic group.

Introduction
Adequate peri-operative care is essential to ensuring a satisfactory outcome in cardiac surgery. In this study, we look at the impact of evidence-based protocols implemented at Stanford Hospital.
Methods
This study is a single-center, retrospective analysis. Enhanced recovery after surgery (ERAS) protocols were implemented for CABG/Valve and open Aortic operations on 11/1/2017 and 6/1/2018, respectively. Propensity-score matched analysis was used to compare 30-day mortality and morbidity of patients from the pre- and post-implementation cohorts. Secondary endpoints included the following: total hospital length of stay (LOS), ICU LOS, time until extubation, and time until urinary catheter removal.
Results
After the implementation of the ERAS protocols for CABG/Valve operations, the median post-op LOS decreased from 7.0 days to 6.1 days (p<0.001), and median ICU LOS decreased from 69.9 hours to 54.0 (p = 0.098). There was no significant decrease in 30-day mortality (4% to 3.3%, p = 0.47). However, the incidence of post-op ventilator associated pneumonia (VAP) decreased from 5.0% to 2.1% (p = 0.003) and post-op urinary tract infections (UTIs) from 8.3% to 3.6% (p<0.001). Patients who underwent open aortic procedures experienced an improvement in 30-day mortality (7% to 3.5%, p = 0.012), decrease in median ICU LOS (91.7 hours to 69.6 hours, p<0.001), and a decrease in duration of mechanical ventilation (79.3 hours to 46.3 hours, p = 0.003). There was a decrease in post-op LOS, post-op VAP, and post-op UTI, although statistical significance was not attained.
Conclusion
At Stanford Hospital, ERAS pathways have led to decreased morbidity and LOS while simultaneously improving mortality amongst our critically ill patient population.

引言
充分的围手术期护理是保障心脏手术获得满意预后的核心前提。本研究旨在评估斯坦福医院（Stanford Hospital）实施的循证护理方案的临床影响。

研究方法
本研究为单中心回顾性分析。分别于2017年11月1日、2018年6月1日针对冠状动脉旁路移植术（Coronary Artery Bypass Graft, CABG）/瓣膜手术以及开放式主动脉手术患者启动术后加速康复（Enhanced Recovery After Surgery, ERAS）方案。采用倾向得分匹配分析，对比实施前后队列患者的30天死亡率与并发症发生率。次要研究终点包括：总住院时长（length of stay, LOS）、重症监护病房（Intensive Care Unit, ICU）停留时长、拔管时间以及导尿管拔除时间。

研究结果
针对CABG/瓣膜手术的ERAS方案实施后，患者术后中位住院时长从7.0天降至6.1天（p<0.001），术后中位ICU停留时长从69.9小时降至54.0小时（p=0.098）。30天死亡率未出现显著下降（从4.0%降至3.3%，p=0.47）。但术后呼吸机相关性肺炎（Ventilator Associated Pneumonia, VAP）发生率从5.0%降至2.1%（p=0.003），术后尿路感染（Urinary Tract Infection, UTI）发生率从8.3%降至3.6%（p<0.001）。接受开放式主动脉手术的患者，其30天死亡率得到改善（从7.0%降至3.5%，p=0.012），中位ICU停留时长缩短（从91.7小时降至69.6小时，p<0.001），机械通气时长亦显著减少（从79.3小时降至46.3小时，p=0.003）。术后住院时长、VAP发生率及UTI发生率虽有下降，但未达到统计学显著性差异。

结论
在斯坦福医院（Stanford Hospital），ERAS路径可降低患者并发症发生率与住院时长，同时改善重症患者群体的死亡率。