Enhanced Recovery After Surgery (ERAS) in Coronary Artery Bypass Graft / Off Pump Coronary Artery Bypass (CABG/OPCAB)

ERAS Implementation in Coronary Artery Bypass Surgery

It has been assumed that some elements of the ERAS protocol may contribute to the reduction of complications and improve the satisfaction of patients undergoing coronary artery bypass surgery.

Elements of the ERAS strategy will be tested in this study. The elements that prove to be feasible and have a positive effect on the treatment process will be introduced into everyday clinical practice.

In the next stage of the research, we are planning to investigate whether the introduction of the ERAS strategy has had a long-term positive effect on the quality of life after treatment (a survey 1 month and 6 months after leaving the hospital).

Evaluation of the impact of implemented elements of the ERAS strategy on the results of surgical treatment of coronary artery disease in the aspect of:

• preoperative preparation (comprehensive information, premedication, hydration),
• haemodynamic stability (discontinuation of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers immediately before surgery), optimal pre- and intraoperative fluid therapy,
• occurrence of respiratory complications (assessment of the duration of mechanical ventilation and passive oxygen therapy),
• demand for painkillers in the postoperative period, after introducing the preemptive strategy,
• incidence of postoperative delirium,
• time to recovery of the normal bowel function (nausea, vomiting),
• possibility of early mobilisation on the first day after surgery,
• patient's satisfaction with treatment assessed on the basis of a survey carried out on the day before leaving the hospital.

Inclusion Criteria:

• CABG/OPCAB (Coronary Artery Bypass Surgery/Off Pump Coronary Bypass Surgery).
• Left ventricular ejection fraction above 35% (EF ≥ 35%).
• The operation was performed in a planned mode.

Exclusion Criteria:

• Haematological diseases and the associated increased risk of bleeding in the early postoperative period. Patients taking anticoagulants until the day of surgery with the exception of aspirin.
• Neurological disorders, stroke with persistent symptoms, dementia.
• Chronic lung disease with hypoxia and the need for regular medication.
• Inability to move independently, disability preventing efficient rehabilitation, prolonged use of painkillers.
• Emergency surgery, reoperation.
• Return to the operating room regardless of the reason (resternotomy).
• Perioperative infarction with circulatory destabilization.