Enhanced Recovery After Surgery in Cardiac Surgery: Imploring Investigation.

We read with enthusiasm Salenger and colleagues’ article 1 Salenger R. Holmes S.D. Rea A. et al. Cardiac enhanced recovery after surgery: early outcomes in a community setting. Ann Thorac Surg. 2022; 113: 2008-2017 Abstract Full Text Full Text PDF Scopus (2) Google Scholar on the impact of cardiac Enhanced Recovery After Surgery (ERAS). Given the value of observational studies, these findings prompted our own systematic review to identify randomized controlled trials (RCTs). Growing minimally invasive and robotic cardiac surgical techniques bring heightened attention to quality and efficient patient care, with the spotlight on cardiac ERAS. Cardiac Enhanced Recovery After Surgery: Early Outcomes in a Community SettingThe Annals of Thoracic SurgeryVol. 113Issue 6PreviewEnhanced Recovery After Surgery (ERAS) programs have demonstrated improved outcomes in noncardiac surgery. More recently, ERAS has been applied to cardiac surgery with promising results. We have implemented cardiac ERAS at our community-based program, aiming to improve all phases of care, and now report our early results. Full-Text PDF Cardiac ERAS in the Community: Real-World Results for Real PatientsThe Annals of Thoracic SurgeryVol. 115Issue 6PreviewWe thank Yoo and colleagues1 for their interest in our study on the impact of cardiac Enhanced Recovery After Surgery (ERAS) in a community cardiac surgery program. Their letter raises the important question of evidence quality supporting cardiac ERAS. We agree that there is a paucity of randomized clinical trials evaluating cardiac ERAS. Although aspirational, quality randomized clinical trials may not be feasible for interventions as extensive as ERAS bundles. Other study designs or analyses such as propensity matching, cluster randomization, or stepped wedge designs may be suitable or more pragmatic alternatives to observational studies. Full-Text PDF