EFFECTS OF ERAS PROTOCOLS ON PATIENT OUTCOMES IN CARDIOVASCULAR SURGERY

This randomized controlled trial was conducted to evaluate the effects of an Enhanced Recovery After Surgery (ERAS) protocol on postoperative recovery and patient outcomes in patients undergoing elective coronary artery bypass grafting (CABG) surgery. The study was conducted in the Cardiovascular Surgery Clinic of Bolu Abant İzzet Baysal University İzzet Baysal Training and Research Hospital. A total of 50 patients who met the eligibility criteria were included in the study and randomly assigned to either the ERAS group (n=25) or the control group (n=25). Patients in the ERAS group received a comprehensive perioperative care program based on ERAS principles. The ERAS program included preoperative oral carbohydrate loading, multimodal analgesia, prevention of postoperative nausea and vomiting, early extubation, respiratory exercises, coughing exercises, early mobilization, and other evidence-based perioperative interventions. Patients in the control group received routine perioperative care according to standard clinical practice. The primary outcomes included quality of recovery and postoperative clinical outcomes. Quality of recovery was assessed using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes included anxiety, pain intensity, nutritional risk, postoperative delirium, and cardiovascular surgery-related symptoms. Clinical recovery outcomes included time to extubation, duration of intensive care unit stay, duration of surgical drain use, time to urinary catheter removal, time to first bowel movement, time to first oral intake, and length of hospital stay. Patients were evaluated at multiple time points throughout the postoperative recovery process. Assessments were performed during the intensive care unit stay, after transfer to the surgical ward, at hospital discharge, and at one week and one month after discharge. These repeated assessments were used to evaluate changes in quality of recovery, anxiety, pain, cardiovascular surgery-related symptoms, and other patient outcomes over time. The study aimed to determine whether implementation of a comprehensive ERAS protocol could improve quality of recovery, reduce postoperative symptoms and anxiety, facilitate earlier recovery, shorten intensive care unit and hospital stays, and contribute to improved clinical outcomes in patients undergoing cardiovascular surgery.

Inclusion criteria

• Being admitted for their first planned coronary artery bypass graft (CABG) surgery;
• Undergoing off-pump coronary artery bypass (OPCAB) surgery without the use of a cardiopulmonary bypass machine;
• Not undergoing any additional surgical procedure during CABG surgery;
• Having no abnormalities in preoperative laboratory parameters, including hemoglobin, albumin, and electrolytes;
• Having no cognitive impairment;
• Having no psychological or mental disorder;
• Being able to speak Turkish and communicate effectively;
• Being at least literate;
• Being 18 years of age or older;
• Being reachable by telephone during the follow-up period; and
• Providing informed consent to participate in the study.

Exclusion criteria

• Having previously undergone CABG surgery;
• Undergoing CABG surgery using cardiopulmonary bypass with the heart arrested;
• Undergoing any additional surgical procedure during CABG surgery;
• Having electrolyte abnormalities in preoperative laboratory parameters;
• Having cognitive impairment;
• Having a psychological or mental disorder;
• Being unable to speak Turkish, communicate effectively, or provide consent to participate in the study;
• Being unable to read and write;
• Being younger than 18 years of age;
• Being unreachable by telephone during the follow-up period;
• Withdrawing from the study after initially agreeing to participate;
• Undergoing any surgical operation after hospital admission; or
• Dying during the study intervention or follow-up period.