The concept and progress of enhanced recovery after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Yi ,  YU Hai

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

YU Hai, Email: yuhaishan117@yahoo.com

Keywords：

Enhanced recovery after surgery; cardiopulmonary bypass; cardiac surgery; review

DOI：

10.7507/1007-4848.202002090

Video：

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Abstract Full text Figures/Tables Video References Cited by

Cardiac surgery has always been one of the major specialties in the development of “fast track surgery”. Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years, and it results in substantial improvements in clinical outcomes and cost savings. This frontier concept has also been increasingly applied and promoted in cardiac surgery. However, compared with other surgical fields, current studies regarding cardiac surgery are still limited in quantity, scale and universality of application. Therefore, this review focuses on current concept and progress of ERAS in adult patients undergoing cardiac surgery with cardiopulmonary bypass, aiming to provide guidance for the establishment of a better framework.

Citation： XU Yi, YU Hai. The concept and progress of enhanced recovery after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1479-1484. doi: 10.7507/1007-4848.202002090 Copy

1.	Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg, 2019, 154(8): 755-766.
2.	田孝東, 楊尹默. 理念更新引領行為進步:《加速康復外科中國專家共識及路徑管理指南(2018版)》外科部分解讀. 協和醫學雜志, 2018, 9(6): 485-489.
3.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
4.	Grant MC, Gibbons MM, Ko CY, et al. Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for improving surgical care and recovery: Focus on anesthesiology for bariatric surgery. Anesth Analg, 2019, 129(1): 51-60.
5.	Giménez-Milà M, Klein AA, Martinez G. Design and implementation of an enhanced recovery program in thoracic surgery. J Thorac Dis, 2016, 8(Suppl 1): S37-S45.
6.	Fleming IO, Garratt C, Guha R, et al. Aggregation of marginal gains in cardiac surgery: feasibility of a perioperative care bundle for enhanced recovery in cardiac surgical patients. J Cardiothorac Vasc Anesth, 2016, 30(3): 665-670.
7.	Krzych ?, Kucewicz-Czech E. It is time for enhanced recovery after surgery in cardiac surgery. Kardiol Pol, 2017, 75(5): 415-420.
8.	Yang L, Kaye AD, Venakatesh AG, et al. Enhanced recovery after cardiac surgery: An update on clinical implications. Int Anesthesiol Clin, 2017, 55(4): 148-162.
9.	Li M, Zhang J, Gan TJ, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. Eur J Cardiothorac Surg, 2018, 54(3): 491-497.
10.	Noss C, Prusinkiewicz C, Nelson G, et al. Enhanced recovery for cardiac surgery. J Cardiothorac Vasc Anesth, 2018, 32(6): 2760-2770.
11.	Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg, 2003, 75(2): S715-S720.
12.	葉家欣, 陳濤, 陳成, 等. 心外科加速康復模式的建立與效果評價. 醫學研究生學報, 2019, 32(11): 1145-1149.
13.	Williams JB, McConnell G, Allender JE, et al. One-year results from the first US-based Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg, 2019, 157(5): 1881-1888.
14.	Sola M, Ramm CJ, Kolarczyk LM, et al. Application of a multidisciplinary enhanced recovery after surgery pathway to improve patient outcomes after transcatheter aortic valve implantation. Am J Cardiol, 2016, 118(3): 418-423.
15.	Zaouter C, Oses P, Assatourian S, et al. Reduced length of hospital stay for cardiac surgery-implementing an optimized perioperative pathway: prospective evaluation of an enhanced recovery after surgery program designed for mini-invasive aortic valve replacement. J Cardiothorac Vasc Anesth, 2019, 33(11): 3010-3019.
16.	Coleman SR, Chen M, Patel S, et al. Enhanced recovery pathways for cardiac surgery. Curr Pain Headache Rep, 2019, 23(4): 28.
17.	Chatterjee S. Commentary: Enhanced recovery after cardiac surgery: A game changer, passing fad, or somewhere in between. J Thorac Cardiovasc Surg, 2019, 157(5): 1889-1890.
18.	Lu SY, Lai Y, Dalia AA. Implementing a cardiac enhanced recovery after surgery protocol: nuts and bolts. J Cardiothorac Vasc Anesth, 2020, 34(11): 3104-3112.
19.	Kolodziej T, Maciejewski T, Mendrala K, et al. Enhanced recovery after cardiac surgery. Kardiochir Torakochirurgia Pol, 2019, 16(1): 32-36.
20.	Baxter R, Squiers J, Conner W, et al. Enhanced recovery after surgery: A narrative review of its application in cardiac surgery. Ann Thorac Surg, 2020, 109(6): 1937-1944.
21.	Gregory AJ, Grant MC, Manning MW, et al. Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) recommendations: An important first step but there is much work to be done. J Cardiothorac Vasc Anesth, 2020, 34(1): 39-47.
22.	Markham T, Wegner R, Hernandez N, et al. Assessment of a multimodal analgesia protocol to allow the implementation of enhanced recovery after cardiac surgery: Retrospective analysis of patient outcomes. J Clin Anesth, 2019, 54: 76-80.
23.	Grant MC, Isada T, Ruzankin P, et al. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg, 2020, 159(4): 1393-1402.
24.	Zaouter C, Imbault J, Labrose L, et al. Association of robotic totally endoscopic coronary artery bypass graft surgery associated with a preliminary cardiac enhanced recovery after surgery program: A retrospective analysis. J Cardiothorac Vasc Anesth, 2015, 29(6): 1489-97.
25.	Arora RC, Brown CH 4th, Sanjanwala RM, et al. "NEW" prehabilitation: A 3-way approach to improve postoperative survival and health-related quality of life in cardiac surgery patients. Can J Cardiol, 2018, 34(7): 839-849.
26.	Stoppe C, Goetzenich A, Whitman G, et al. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. Crit Care, 2017, 21(1): 131.
27.	Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev, 2014, 8: CD009161.
28.	Kim MP, Godoy C, Nguyen DT, et al. Preemptive pain-management program is associated with reduction of opioid prescriptions after benign minimally invasive foregut surgery. J Thorac Cardiovasc Surg, 2020, 159(2): 734-744.
29.	Bignami E, Castella A, Pota V, et al. Perioperative pain management in cardiac surgery: A systematic review. Minerva Anestesiol, 2018, 84(4): 488-503.
30.	Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: A review. JAMA Surg, 2017, 152(7): 691-697.
31.	Kelava M, Alfirevic A, Bustamante S, et al. Regional anesthesia in cardiac surgery: An overview of fascial plane chest wall blocks. Anesth Analg, 2020, 131(1): 127-135.
32.	Jack JM, McLellan E, Versyck B, et al. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: A qualitative systematic review. Anaesthesia, 2020, 75(10): 1372-1385.
33.	Li P, Qu LP, Qi D, et al. Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review. Ann Med, 2017, 49(4): 343-351.
34.	Joosten A, Delaporte A, Ickx B, et al. Crystalloid versus colloid for intraoperative goal-directed fluid therapy using a closed-loop system: A randomized, double-blinded, controlled trial in major abdominal surgery. Anesthesiology, 2018, 128(1): 55-66.
35.	Blaudszun G, Butchart A, Klein AA. Blood conservation in cardiac surgery. Transfus Med, 2018, 28(2): 168-180.
36.	Pagano D, Milojevic M, Meesters MI, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg, 2018, 53(1): 79-111.
37.	Adam EH, Funke M, Zacharowski K, et al. Impact of intraoperative cell salvage on blood coagulation factor concentrations in patients undergoing cardiac surgery. Anesth Analg, 2020, 130(5): 1389-1395.
38.	Zochios V, Klein AA, Gao F. Protective invasive ventilation in cardiac surgery: A systematic review with a focus on acute lung injury in adult cardiac surgical patients. J Cardiothorac Vasc Anesth, 2018, 32(4): 1922-36.
39.	Bignami E, Guarnieri M, Saglietti F, et al. Mechanical ventilation during cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2016, 30(6): 1668-1675.
40.	Chi D, Chen C, Shi Y, et al. Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency: A meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(12): e6454.
41.	Lagier D, Fischer F, Fornier W, et al. Effect of open-lung vs. conventional perioperative ventilation strategies on postoperative pulmonary complications after on-pump cardiac surgery: the PROVECS randomized clinical trial. Intensive Care Med, 2019, 45(10): 140-1412.
42.	Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
43.	Chan JL, Miller JG, Murphy M, et al. A multidisciplinary protocol-driven approach to improve extubation times after cardiac surgery. Ann Thorac Surg, 2018, 105(6): 1684-1690.
44.	Totonchi Z, Azarfarin R, Jafari L, et al. Feasibility of on-table extubation after cardiac surgery with cardiopulmonary bypass: A randomized clinical trial. Anesth Pain Med, 2018, 8(5): e80158.
45.	Subramaniam K, DeAndrade DS, Mandell DR, et al. Predictors of operating room extubation in adult cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(5): 1656-1665.
46.	J?rvel? K, Porkkala H, Karlsson S, et al. Postoperative delirium in cardiac surgery patients. J Cardiothorac Vasc Anesth, 2018, 32(4): 1597-1602.
47.	Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg, 2014, 118(1): 85-113.
48.	Wang EHZ, Sunderland S, Edwards NY, et al. A single prophylactic dose of ondansetron given at cessation of postoperative propofol sedation decreases postoperative nausea and vomiting in cardiac surgery patients: A randomized controlled trial. Anesth Analg, 2020, 131(4): 1164-1172.
49.	Devlin JW, Skrobik Y, Gélinas C, et al. Executive summary: clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 2018, 46(9): 1532-1548.
50.	Shetty RM, Bellini A, Wijayatilake DS, et al. BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization. Cochrane Database Syst Rev, 2018, 2: CD011240.
51.	Lei L, Katznelson R, Fedorko L, et al. Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial. Anaesthesia, 2017, 72(12): 1456-1466.
52.	Hughes CG, Boncyk CS, Culley DJ, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint consensus statement on postoperative delirium prevention. Anesth Analg, 2020, 130(6): 1572-1590.
53.	Muller Moran HR, Maguire D, Maguire D, et al. Association of earlier extubation and postoperative delirium after coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2020, 159(1): 182-190.
54.	Myles PS. More than just morbidity and mortality-quality of recovery and long-term functional recovery after surgery. Anaesthesia, 2020, 75(Suppl 1): e143-e150.
55.	Lavallee DC, Chenok KE, Love RM, et al. Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff, 2016, 35(4): 575-82.
56.	Baron SJ, Arnold SV, Wang K, et al. Health status benefits of transcatheter vs. surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk: results from the PARTNER 2 randomized clinical trial. JAMA Cardiol, 2017, 2(8): 837-845.
57.	Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R, et al. Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the postoperative outcomes within enhanced recovery after surgery protocol (POWER) study. JAMA Surg, 2019, 154(8): 725-736.

1. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg, 2019, 154(8): 755-766.
2. 田孝東, 楊尹默. 理念更新引領行為進步:《加速康復外科中國專家共識及路徑管理指南(2018版)》外科部分解讀. 協和醫學雜志, 2018, 9(6): 485-489.
3. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
4. Grant MC, Gibbons MM, Ko CY, et al. Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for improving surgical care and recovery: Focus on anesthesiology for bariatric surgery. Anesth Analg, 2019, 129(1): 51-60.
5. Giménez-Milà M, Klein AA, Martinez G. Design and implementation of an enhanced recovery program in thoracic surgery. J Thorac Dis, 2016, 8(Suppl 1): S37-S45.
6. Fleming IO, Garratt C, Guha R, et al. Aggregation of marginal gains in cardiac surgery: feasibility of a perioperative care bundle for enhanced recovery in cardiac surgical patients. J Cardiothorac Vasc Anesth, 2016, 30(3): 665-670.
7. Krzych ?, Kucewicz-Czech E. It is time for enhanced recovery after surgery in cardiac surgery. Kardiol Pol, 2017, 75(5): 415-420.
8. Yang L, Kaye AD, Venakatesh AG, et al. Enhanced recovery after cardiac surgery: An update on clinical implications. Int Anesthesiol Clin, 2017, 55(4): 148-162.
9. Li M, Zhang J, Gan TJ, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. Eur J Cardiothorac Surg, 2018, 54(3): 491-497.
10. Noss C, Prusinkiewicz C, Nelson G, et al. Enhanced recovery for cardiac surgery. J Cardiothorac Vasc Anesth, 2018, 32(6): 2760-2770.
11. Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg, 2003, 75(2): S715-S720.
12. 葉家欣, 陳濤, 陳成, 等. 心外科加速康復模式的建立與效果評價. 醫學研究生學報, 2019, 32(11): 1145-1149.
13. Williams JB, McConnell G, Allender JE, et al. One-year results from the first US-based Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg, 2019, 157(5): 1881-1888.
14. Sola M, Ramm CJ, Kolarczyk LM, et al. Application of a multidisciplinary enhanced recovery after surgery pathway to improve patient outcomes after transcatheter aortic valve implantation. Am J Cardiol, 2016, 118(3): 418-423.
15. Zaouter C, Oses P, Assatourian S, et al. Reduced length of hospital stay for cardiac surgery-implementing an optimized perioperative pathway: prospective evaluation of an enhanced recovery after surgery program designed for mini-invasive aortic valve replacement. J Cardiothorac Vasc Anesth, 2019, 33(11): 3010-3019.
16. Coleman SR, Chen M, Patel S, et al. Enhanced recovery pathways for cardiac surgery. Curr Pain Headache Rep, 2019, 23(4): 28.
17. Chatterjee S. Commentary: Enhanced recovery after cardiac surgery: A game changer, passing fad, or somewhere in between. J Thorac Cardiovasc Surg, 2019, 157(5): 1889-1890.
18. Lu SY, Lai Y, Dalia AA. Implementing a cardiac enhanced recovery after surgery protocol: nuts and bolts. J Cardiothorac Vasc Anesth, 2020, 34(11): 3104-3112.
19. Kolodziej T, Maciejewski T, Mendrala K, et al. Enhanced recovery after cardiac surgery. Kardiochir Torakochirurgia Pol, 2019, 16(1): 32-36.
20. Baxter R, Squiers J, Conner W, et al. Enhanced recovery after surgery: A narrative review of its application in cardiac surgery. Ann Thorac Surg, 2020, 109(6): 1937-1944.
21. Gregory AJ, Grant MC, Manning MW, et al. Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) recommendations: An important first step but there is much work to be done. J Cardiothorac Vasc Anesth, 2020, 34(1): 39-47.
22. Markham T, Wegner R, Hernandez N, et al. Assessment of a multimodal analgesia protocol to allow the implementation of enhanced recovery after cardiac surgery: Retrospective analysis of patient outcomes. J Clin Anesth, 2019, 54: 76-80.
23. Grant MC, Isada T, Ruzankin P, et al. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg, 2020, 159(4): 1393-1402.
24. Zaouter C, Imbault J, Labrose L, et al. Association of robotic totally endoscopic coronary artery bypass graft surgery associated with a preliminary cardiac enhanced recovery after surgery program: A retrospective analysis. J Cardiothorac Vasc Anesth, 2015, 29(6): 1489-97.
25. Arora RC, Brown CH 4th, Sanjanwala RM, et al. "NEW" prehabilitation: A 3-way approach to improve postoperative survival and health-related quality of life in cardiac surgery patients. Can J Cardiol, 2018, 34(7): 839-849.
26. Stoppe C, Goetzenich A, Whitman G, et al. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. Crit Care, 2017, 21(1): 131.
27. Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev, 2014, 8: CD009161.
28. Kim MP, Godoy C, Nguyen DT, et al. Preemptive pain-management program is associated with reduction of opioid prescriptions after benign minimally invasive foregut surgery. J Thorac Cardiovasc Surg, 2020, 159(2): 734-744.
29. Bignami E, Castella A, Pota V, et al. Perioperative pain management in cardiac surgery: A systematic review. Minerva Anestesiol, 2018, 84(4): 488-503.
30. Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: A review. JAMA Surg, 2017, 152(7): 691-697.
31. Kelava M, Alfirevic A, Bustamante S, et al. Regional anesthesia in cardiac surgery: An overview of fascial plane chest wall blocks. Anesth Analg, 2020, 131(1): 127-135.
32. Jack JM, McLellan E, Versyck B, et al. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: A qualitative systematic review. Anaesthesia, 2020, 75(10): 1372-1385.
33. Li P, Qu LP, Qi D, et al. Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review. Ann Med, 2017, 49(4): 343-351.
34. Joosten A, Delaporte A, Ickx B, et al. Crystalloid versus colloid for intraoperative goal-directed fluid therapy using a closed-loop system: A randomized, double-blinded, controlled trial in major abdominal surgery. Anesthesiology, 2018, 128(1): 55-66.
35. Blaudszun G, Butchart A, Klein AA. Blood conservation in cardiac surgery. Transfus Med, 2018, 28(2): 168-180.
36. Pagano D, Milojevic M, Meesters MI, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg, 2018, 53(1): 79-111.
37. Adam EH, Funke M, Zacharowski K, et al. Impact of intraoperative cell salvage on blood coagulation factor concentrations in patients undergoing cardiac surgery. Anesth Analg, 2020, 130(5): 1389-1395.
38. Zochios V, Klein AA, Gao F. Protective invasive ventilation in cardiac surgery: A systematic review with a focus on acute lung injury in adult cardiac surgical patients. J Cardiothorac Vasc Anesth, 2018, 32(4): 1922-36.
39. Bignami E, Guarnieri M, Saglietti F, et al. Mechanical ventilation during cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2016, 30(6): 1668-1675.
40. Chi D, Chen C, Shi Y, et al. Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency: A meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(12): e6454.
41. Lagier D, Fischer F, Fornier W, et al. Effect of open-lung vs. conventional perioperative ventilation strategies on postoperative pulmonary complications after on-pump cardiac surgery: the PROVECS randomized clinical trial. Intensive Care Med, 2019, 45(10): 140-1412.
42. Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
43. Chan JL, Miller JG, Murphy M, et al. A multidisciplinary protocol-driven approach to improve extubation times after cardiac surgery. Ann Thorac Surg, 2018, 105(6): 1684-1690.
44. Totonchi Z, Azarfarin R, Jafari L, et al. Feasibility of on-table extubation after cardiac surgery with cardiopulmonary bypass: A randomized clinical trial. Anesth Pain Med, 2018, 8(5): e80158.
45. Subramaniam K, DeAndrade DS, Mandell DR, et al. Predictors of operating room extubation in adult cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(5): 1656-1665.
46. J?rvel? K, Porkkala H, Karlsson S, et al. Postoperative delirium in cardiac surgery patients. J Cardiothorac Vasc Anesth, 2018, 32(4): 1597-1602.
47. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg, 2014, 118(1): 85-113.
48. Wang EHZ, Sunderland S, Edwards NY, et al. A single prophylactic dose of ondansetron given at cessation of postoperative propofol sedation decreases postoperative nausea and vomiting in cardiac surgery patients: A randomized controlled trial. Anesth Analg, 2020, 131(4): 1164-1172.
49. Devlin JW, Skrobik Y, Gélinas C, et al. Executive summary: clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 2018, 46(9): 1532-1548.
50. Shetty RM, Bellini A, Wijayatilake DS, et al. BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization. Cochrane Database Syst Rev, 2018, 2: CD011240.
51. Lei L, Katznelson R, Fedorko L, et al. Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial. Anaesthesia, 2017, 72(12): 1456-1466.
52. Hughes CG, Boncyk CS, Culley DJ, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint consensus statement on postoperative delirium prevention. Anesth Analg, 2020, 130(6): 1572-1590.
53. Muller Moran HR, Maguire D, Maguire D, et al. Association of earlier extubation and postoperative delirium after coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2020, 159(1): 182-190.
54. Myles PS. More than just morbidity and mortality-quality of recovery and long-term functional recovery after surgery. Anaesthesia, 2020, 75(Suppl 1): e143-e150.
55. Lavallee DC, Chenok KE, Love RM, et al. Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff, 2016, 35(4): 575-82.
56. Baron SJ, Arnold SV, Wang K, et al. Health status benefits of transcatheter vs. surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk: results from the PARTNER 2 randomized clinical trial. JAMA Cardiol, 2017, 2(8): 837-845.
57. Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R, et al. Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the postoperative outcomes within enhanced recovery after surgery protocol (POWER) study. JAMA Surg, 2019, 154(8): 725-736.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The concept and progress of enhanced recovery after cardiac surgery

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