Enhanced Recovery Protocols for Cardiac Surgery: Moving the Saw in the Right Direction

2021 ◽  
Author(s):  
Nicholas R. Hess ◽  
Danny Chu
Keyword(s):  
Cardiac Surgery ◽  
Enhanced Recovery ◽  
Recovery Protocols ◽  
The Right

scholarly journals Expanding Enhanced Recovery Protocols for Cardiac Surgery to Include the Patient Voice: a Scoping Review Protocol

2020 ◽  
Author(s):  
Nebojša Oravec ◽  
Rakesh C. Arora ◽  
Brian Bjorklund ◽  
April Gregora ◽  
Caroline Monnin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Lived Experience ◽  
Scoping Review ◽  
Enhanced Recovery ◽  
Research Question ◽  
Grey Literature ◽  
Perioperative Period ◽  
Added Value ◽  
Cochrane Library ◽  
Recovery Protocols

Abstract Background Cardiac surgery is becoming increasingly common in older, more vulnerable adults. A focus on timely and complete medical and functional recovery has led to the development of enhanced recovery protocols (ERPs) for a number of surgical procedures and subspecialties, including cardiac surgery (ERAS® Cardiac). An element that is often overlooked in the development and implementation of ERPs is the involvement of key stakeholder groups, including surgery patients and caregivers (e.g., family and/or friends). The aim of this study is to describe a protocol for a scoping review of cardiac patient and caregiver preferences and outcomes relevant to cardiac surgery ERPs. Methods Using Arskey and O’Malley’s six-stage framework for scoping review methodologies with adaptions from Levac et al., a scoping review of existing literature describing patient- and caregiver-identified preferences and outcomes as they relate to care received in the perioperative period of cardiac surgery will be undertaken. The search for relevant articles will be conducted using electronic databases (i.e., the Cochrane Library, Medline, PsycINFO, Scopus, and Embase), as well as through a search of the grey literature (e.g., CPG Infobase, Heart and Stroke Foundation, ProQuest Theses and Dissertations, Google Advanced and Prospero). Published and unpublished full-text articles written in English, published after the year 2000, and that relate to the research question will be included. Central to the design of this scoping review is our collaboration with two patient partners who possess lived experience as cardiac surgery patients. Discussion This review will identify strategies that can be integrated into ERPs for cardiac surgery which align with patient- and caregiver-defined values. Broadly, it is our goal to demonstrate the added value of patient engagement in research to aid in the success of system change processes.

scholarly journals Expanding enhanced recovery protocols for cardiac surgery to include the patient voice: A scoping review protocol

2020 ◽  
Author(s):  
Nebojša Oravec ◽  
Rakesh C. Arora ◽  
Brian Bjorklund ◽  
April Gregora ◽  
Caroline Monnin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Lived Experience ◽  
Scoping Review ◽  
Enhanced Recovery ◽  
Research Question ◽  
Grey Literature ◽  
Perioperative Period ◽  
Added Value ◽  
Cochrane Library ◽  
Recovery Protocols

Abstract BackgroundCardiac surgery is becoming increasingly common in older, more vulnerable adults. A focus on timely and complete medical and functional recovery has led to the development of enhanced recovery protocols (ERPs) for a number of surgical procedures and subspecialties, including cardiac surgery (ERAS® Cardiac). An element that is often overlooked in the development and implementation of ERPs is the involvement of key stakeholder groups, including surgery patients and caregivers (e.g., family and/or friends). The aim of this study is to describe a protocol for a scoping review of cardiac patient and caregiver preferences and outcomes relevant to cardiac surgery ERPs. MethodsUsing Arskey and O’Malley’s six-stage framework for scoping review methodologies with adaptions from Levac et al., a scoping review of existing literature describing patient- and caregiver-identified preferences and outcomes as they relate to care received in the perioperative period of cardiac surgery will be undertaken. The search for relevant articles will be conducted using electronic databases (i.e., the Cochrane Library, Medline, PsycINFO, Scopus, and Embase), as well as through a search of the grey literature (e.g., CPG Infobase, Heart and Stroke Foundation, ProQuest Theses and Dissertations, Google Advanced and Prospero). Published and unpublished full-text articles written in English, published after the year 2000, and that relate to the research question will be included. Central to the design of this scoping review is our collaboration with two patient partners who possess lived experience as cardiac surgery patients.DiscussionThis review will identify strategies that can be integrated into ERPs for cardiac surgery which align with patient- and caregiver-defined values. Broadly, it is our goal to demonstrate the added value of patient engagement in research to aid in the success of system change processes.

scholarly journals Expanding enhanced recovery protocols for cardiac surgery to include the patient voice: a scoping review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Nebojša Oravec ◽  
Rakesh C. Arora ◽  
Brian Bjorklund ◽  
April Gregora ◽  
Caroline Monnin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Lived Experience ◽  
Scoping Review ◽  
Enhanced Recovery ◽  
Research Question ◽  
Grey Literature ◽  
Perioperative Period ◽  
Added Value ◽  
Cochrane Library ◽  
Recovery Protocols

Abstract Background Cardiac surgery is becoming increasingly common in older, more vulnerable adults. A focus on timely and complete medical and functional recovery has led to the development of enhanced recovery protocols (ERPs) for a number of surgical procedures and subspecialties, including cardiac surgery (ERAS® Cardiac). An element that is often overlooked in the development and implementation of ERPs is the involvement of key stakeholder groups, including surgery patients and caregivers (e.g., family and/or friends). The aim of this study is to describe a protocol for a scoping review of cardiac patient and caregiver preferences and outcomes relevant to cardiac surgery ERPs. Methods Using Arksey and O’Malley’s et al six-stage framework for scoping review methodologies with adaptions from Levac et al. (Represent Interv: 1–18, 2012), a scoping review of existing literature describing patient- and caregiver-identified preferences and outcomes as they relate to care received in the perioperative period of cardiac surgery will be undertaken. The search for relevant articles will be conducted using electronic databases (i.e., the Cochrane Library, Medline, PsycINFO, Scopus, and Embase), as well as through a search of the grey literature (e.g., CPG Infobase, Heart and Stroke Foundation, ProQuest Theses and Dissertations, Google Advanced, and Prospero). Published and unpublished full-text articles written in English, published after the year 2000, and that relate to the research question will be included. Central to the design of this scoping review is our collaboration with two patient partners who possess lived experience as cardiac surgery patients. Discussion This review will identify strategies that can be integrated into ERPs for cardiac surgery which align with patient- and caregiver-defined values. Broadly, it is our goal to demonstrate the added value of patient engagement in research to aid in the success of system change processes.

scholarly journals Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study (Preprint)

2020 ◽  
Author(s):  
Anna M Chudyk ◽  
Sandra Ragheb ◽  
David Kent ◽  
Todd A Duhamel ◽  
Carole Hyra ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mobile Health ◽  
Patient Engagement ◽  
Enhanced Recovery ◽  
Perioperative Period ◽  
End Users ◽  
Advisory Panel ◽  
Patient Centered ◽  
Recovery Protocols ◽  
The Impact

BACKGROUND Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. OBJECTIVE The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. METHODS Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. RESULTS The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. CONCLUSIONS Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

scholarly journals Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study

10.2196/26597 ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. e26597
Author(s):  
Anna M Chudyk ◽  
Sandra Ragheb ◽  
David Kent ◽  
Todd A Duhamel ◽  
Carole Hyra ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mobile Health ◽  
Patient Engagement ◽  
Enhanced Recovery ◽  
Perioperative Period ◽  
End Users ◽  
Advisory Panel ◽  
Patient Centered ◽  
Recovery Protocols ◽  
The Impact

Background Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

scholarly journals Enhanced Recovery After Cardiac Surgery: Where Do We Stand?

2021 ◽  
Author(s):  
Alexander Gebauer ◽  
Johannes Petersen ◽  
Johanna Konertz ◽  
Jens Brickwedel ◽  
Leonie Schulte-Uentrop ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Quality Data ◽  
Non Profit ◽  
Recovery Protocols ◽  
The Many ◽  
Guidelines And Recommendations ◽  
Evidence Based Guidelines

Abstract Purpose of Review Enhanced recovery after surgery (ERAS) protocols are multimodal and multi-professional strategies to enhance postoperative convalescence and thereby reduce the length of hospital stay and hospital-associated complications. This review provides an up-to-date overview about basic principles of enhanced recovery after surgery protocols, their transfer into cardiac surgery, and their current state of evidence. It is supposed to offer clinical implications for further adaptations and implementations of such protocols in cardiac surgery. Recent Findings ERAS protocols are a story of success in numerous surgical disciplines and led to a paradigm shift in perioperative care and the establishment of ERAS Cardiac Society, a non-profit organization that provides evidence-based guidelines and recommendations for further development of enhanced recovery protocols, trying to harmonize the many existing efforts of individual approaches for cardiac surgery. Summary Promising results from comprehensive ERAS protocols in cardiac surgery emerged. Nevertheless, there is a paucity of high-quality data about holistic approaches in cardiac surgery and further efforts need to be promoted.

Elderly Patients Benefit From Enhanced Recovery Protocols After Colorectal Surgery

2021 ◽  
Vol 266 ◽  
pp. 54-61
Author(s):  
Jessica Y Liu ◽  
Sebastian D Perez ◽  
Glen G Balch ◽  
Patrick S Sullivan ◽  
Jahnavi K Srinivasan ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Elderly Patients ◽  
Enhanced Recovery ◽  
Recovery Protocols

Expert Consensus of Data Elements for Collection for Enhanced Recovery After Cardiac Surgery

2021 ◽  
Author(s):  
Sameer A. Hirji ◽  
Rawn Salenger ◽  
Edward M. Boyle ◽  
Judson Williams ◽  
V. Seenu Reddy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Enhanced Recovery ◽  
Expert Consensus ◽  
Data Elements

scholarly journals Multiple pericardial hematomas: a case report and mini-review in multimodality imaging

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aninka Saboe ◽  
Ferdy Sanjaya ◽  
Raden Erwin Affandi Soeriadi ◽  
Euis Maryani ◽  
Nuraini Yasmin Kusumawardhani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Imaging ◽  
Single Photon ◽  
Multimodality Imaging ◽  
Photon Emission ◽  
Vena Cava ◽  
Intracardiac Thrombus ◽  
Surgical Closure ◽  
The Right

Abstract Background Pericardial hematoma is blood accumulation in the pericardial space. Although rare, it could arise in various conditions, such as after cardiac surgery. Clinical diagnosis of pericardial hematoma is implausible; thus, cardiac imaging plays a pivotal role in identifying this condition. We presented a case of multiple pericardial hematomas, which was found as an incidental finding in post-cardiac surgery evaluation. We highlighted the diagnostic challenge and the key features of multi-modality cardiac imaging in pericardial hematoma evaluation. Case presentation An asymptomatic, 35-years old male, who underwent surgical closure of secundum atrial septal defect (ASD) one month ago, came for routine transthoracic echocardiography evaluation. An intrapericardiac hematoma was visualized at the right ventricle (RV) 's free wall side. Another mass with an indistinct border was visualized near the right atrium (RA). This mass was suspected as pericardial hematoma differential diagnosed with intracardiac thrombus. Cardiac computed tomography (CT) scan showed both masses have an attenuation of 30–40 HU; however, the mass's border at the RA side was still not clearly delineated. Mild superior vena cava (SVC) compression and multiple mediastinal lymphadenopathies were also detected. These findings are not typical for pericardial hematomas nor intracardiac thrombus; hence another additional differential diagnosis of pericardial neoplasm was considered. We pursued further cardiac imaging modalities because the patient refused to undergo an open biopsy. Single-photon emission computer tomography (SPECT)/CT with Technetium-99 m (Tc-99 m) macro-aggregated albumin (MAA) and Sestamibi showed filling defect without increased radioactivity, thus exclude the intracardiac thrombus. Cardiac magnetic resonance imaging (MRI) reveals intrapericardial masses with low intensity of T1 signal and heterogeneously high intensity on T2 signal weighted imaged and no evidence of gadolinium enhancement, which concluded the diagnosis as subacute pericardial hematomas. During follow-up, the patient remains asymptomatic, and after six months, the pericardial hematomas were resolved. Conclusion Pericardial hematoma should be considered as a cause of pericardial masses after cardiac surgery. When imaging findings are atypical, further multi-modality cardiac imaging must be pursued to establish the diagnosis. Careful and meticulous follow-up should be considered for an asymptomatic patient with stable hemodynamic.

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