ERAS Compliance and Nutritional Outcomes After Open Heart Surgery

Patients undergoing open heart surgery are at increased risk of postoperative complications and delayed recovery because of surgical trauma, cardiopulmonary bypass-related inflammation, metabolic stress, and temporary organ dysfunction. ERAS protocols use evidence-based multimodal perioperative care components to reduce surgical stress and improve recovery.

This single-center, prospective observational cohort study will include 120 adult patients undergoing elective open heart surgery through median sternotomy under general anesthesia. All participants will receive routine perioperative care according to the institutional cardiac surgery ERAS protocol. The study will not assign participants to an intervention, alter routine treatment, or require any additional invasive procedure.

Compliance with predefined ERAS components will be assessed during the preoperative, intraoperative, and postoperative periods. Each implemented component will receive one point, and each non-implemented component will receive zero points. The number of implemented components will be divided by the total number of applicable components to calculate an overall ERAS compliance percentage. Participants will subsequently be categorized into high-compliance (≥80%), moderate-compliance (60-79%), and low-compliance (<60%) groups.

Nutritional risk will be evaluated using NRS-2002 before surgery and at postoperative 48 hours. PNI will be calculated at the same time points using serum albumin concentration and total lymphocyte count. Frailty will be evaluated preoperatively using the Clinical Frailty Scale, and operative mortality risk will be estimated using EuroSCORE II.

The study will examine changes in nutritional risk and PNI and their associations with ERAS compliance. Postoperative complications, intensive care unit length of stay, total hospital length of stay, and readmission within 30 days will also be recorded. Relationships among ERAS compliance, nutritional parameters, frailty, surgical risk, and postoperative clinical outcomes will be analyzed.

Inclusion criteria

• Aged 18 to 85 years
• Scheduled to undergo elective open heart surgery through median sternotomy under general anesthesia
• Able to provide written informed consent

Exclusion criteria

• Emergency cardiac surgery
• Preoperative total parenteral nutrition
• End-stage renal disease or severe hepatic failure
• Uncontrolled metabolic disease, including uncontrolled diabetes mellitus or hypertension
• Active infection
• Cognitive or mental impairment preventing valid informed consent
• Pregnancy, suspected pregnancy, or breastfeeding