ERAS for Cardiac Surgery

I have been utilizing ERAS in general surgery, OB, and ortho cases.  Diving into one of my more tricky populations, I opted to see what ERAS practices are out there for cardiac surgery.  Careful what you look for my friends.  There’s actually a good amount of information out there!

ACCRAC podcast: ERAS for Cardiac Surgery

ERAS Cardiac Consensus Abstract – April 2018

Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. European Journal of Cardio-Thoracic Surgery, Volume 54, Issue 3, 1 September 2018, Pages 491–497, https://doi.org/10.1093/ejcts/ezy100

** Audio PPT ** American Association for Thoracic Surgery: Enhanced Recovery After Cardiac Surgery. April 2018

The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer.  The Journal of Thoracic and Cardiovascular Surgery. April 2018Volume 155, Issue 4, Pages 1843–1852. 

Enhanced Recovery for Cardiac Surgery. J Cardiothorac Vasc Anesth. 2018 Jan 31. pii: S1053-0770(18)30049-1. DOI: https://doi.org/10.1053/j.jvca.2018.01.045

ERAS
From Journal of Anesthesiology

Enhanced Recovery After Cardiac Surgery Society

My blog posts:

Key Points

  • Level 1 (Class of recommendation=Strong Benefit):
    • Tranexamic acid or epsilon aminocaproic acid should be administered for on-pump cardiac surgical procedures to reduce blood loss.
    • Perioperative glycemic control is recommended (BS 70-180; [110-150]).
    • A care bundle of best practices should be performed to reduce surgical site infection.
    • Goal-directed therapy should be performed to reduce postoperative complications.
    • A multimodal, opioid-sparing, pain management plan is recommended postoperatively
    • Persistent hypothermia (T<35o C) after CPB should be avoided in the early postoperative period. Additionally, hyperthermia (T>38oC) should be avoided in the early postoperative period.
    • Active maintenance of chest tube patency is effective at preventing retained blood syndrome.
    • Post-operative systematic delirium screening is recommended at least once per nursing shift.
    • An ICU liberation bundle should be implemented including delirium screening, appropriate sedation and early mobilization.
    • Screening and treatment for excessive alcohol and cigarette smoking should be performed preoperatively when feasible.
  • Level IIa (Class of recommendation=Moderate Benefit)
    • Biomarkers can be beneficial in identifying patients at risk for acute kidney injury.
    • Rigid sternal fixation can be useful to reduce mediastinal wound complications.
    • Prehabilitation is beneficial for patients undergoing elective cardiac surgery with multiple comorbidities or significant deconditioning.
    • Insulin infusion is reasonable to be performed to treat hyperglycemia in all patients in the perioperative period.
    • Early extubation strategies after surgery are reasonable to be employed.
    • Patient engagement through online or application-based systems to promote education, compliance, and patient reported outcomes can be useful.
    • Chemical thromboprophylaxis can be beneficial following cardiac surgery.
    • Preoperative assessment of hemoglobin A1c and albumin is reasonable to be performed.
    • Correction of nutritional deficiency, when feasible, can be beneficial.
  • Level IIb (Class of recommendation=Weak Benefit)
    • A clear liquid diet may be considered to be continued up until 4 hours before general anesthesia.
    • Carbohydrate loading may be considered before surgery.

 

ERAS for cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia

Money, Finances, and Retirement

These 3 items often give people an upset stomach when talking about the future and planning.

My parents were budgeters… not because they enjoyed it, but because they didn’t have the means to be extravagant. I grew up in a two parent working household and that was to make ends meet. I was extremely fortunate that my parents valued my future, and it was evidenced in how they spent and saved their money. Home cooked meals were the norm — until I started in activities that kept me at lessons or practice from the time school recessed until the late evening. I never questioned the sacrifices they made nor the financial understanding of what they were doing. I’ve learned a lot from how they spent their money, and it’s something I want to pass on to my kid(s).

When I look around at people and their spending habits, I’m appalled at what they purchase. Eating meals out every night…. buying tons of clothes/makeup/shoes…. these are just some of the things that just seem to be wasteful to me. Do I do it? Yes, but minimally. Do I think about it every time and wonder if it’s worth it? Absolutely. But, it’s never too late to start a plan or get on track to be financially savvy or responsible.

If you’ve just graduated high school…. here’s a great place to start: What I Wish I’d Known at 18 from Physician on Fire.

Helpful links to tackle:

x-books-about-money


Updated March 19, 2019

I’m always curious as to what others are doing for financial success.  Do people do side hustles?  Are you guys knowledgeable in stocks and options?  Are some really savvy at retirement accounts?  What are people doing these days to plan for a solid financial future?

A couple of years ago, I came across a website called White Coat Investor.   I got an Audible book of White Coat Investor and I wish I had it while in college and about to enter medical school.  I continue to be on their email list bc it’s one of the few websites I found that includes helpful financial tips in a newsletter.  The one I came across today was a subsidiary of WCI, called Physician on Fire.  They have a great post on The Cash Balance Plan, which our group started offering to us a couple of years ago.  It’s worth a read…as are most of the articles at POF.

About a week ago, I got an email and followup call from a consulting firm requesting various advice/expertise on medical devices.  This was the first time I had been contacted re: a consulting opportunity.

Another thing I could use is more diversification of my stock/investment portfolio.  Here’s a great article for considering adding new asset classes.

Side Hustles for Physicians

 


Backdoor Roth

What is a backdoor roth?

Is it worth it to setup?

How to setup a backdoor roth:

Ways to screw up a backdoor roth IRA

 

 

Money, Finances, and Retirement

These 3 items often give people an upset stomach when talking about the future and planning.

My parents were budgeters… not bc they enjoyed it, but because they didn’t have the means to be extravagant. I grew up in two parent working household and that was to make ends meet. I was extremely fortunate that my parents valued my future, and it was evidenced in how they spent and saved their money. Home cooked meals were the norm — until I started in activities that kept me at lessons or practice from the time school recessed until the late evening. I never dove into the sacrifices they made nor the financial understanding of what they were doing. I’ve learned a lot from how they spent their money, and it’s something I want to pass on to my kid(s).

When I look around at people and their spending habits, I’m appalled at what they purchase. Eating meals out every night…. buying tons of clothes/makeup/shoes…. these are just some of the things that just seem to be wasteful to me. Do I do it? Yes, but minimally. Do I think about it every time and wonder if it’s worth it? Absolutely. But, it’s never too late to start a plan or get on track to be financially savvy or responsible.
Helpful links to tackle:

x-books-about-money