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Reduction in Cardiac Arrhythmias Within an Enhanced Recovery After Surgery Program in Colorectal Surgery

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to achieve early recovery by preserving preoperative organ function and minimizing the stress response following surgery. Few studies have assessed the association between ERAS and postoperative cardiac complications. The goal of this study is to evaluate the impact of ERAS on postoperative cardiac complications.

Materials and Methods

A retrospective review of a prospectively maintained database of colorectal patients who underwent surgery at a tertiary colorectal cancer referral center was carried out. Preoperative, intraoperative, and postoperative factors including demographics, comorbidities, medications, and fluid administration were recorded. The primary outcome was postoperative cardiac arrhythmia, and secondary outcomes included other postoperative complications.

Results

A total of 800 patients who underwent elective colorectal surgery were identified. Four hundred seventeen patients (52%) were in the control group and 383 patients (48%) were in the ERAS group. Patients in both groups were similar with regard to demographics and clinical characteristics. There were significantly higher rates of cardiac arrhythmia in the control group (5.3%) compared with the ERAS group (1.8%), p = 0.009. Multivariable analysis revealed that ERAS was an independent predictor of decreased postoperative cardiac arrhythmia (OR 0.30, 95%CI 0.17–0.55, p < 0.001) while older age was an independent predictor of increased postoperative cardiac arrhythmia (OR 1.08, 95%CI 1.02–1.13, p = 0.008). Patients receiving lower amounts of intravenous fluids had significantly decreased postoperative cardiac arrhythmia (OR = 0.25, 95%CI 0.09–0.67, p = 0.006).

Conclusions

ERAS and goal-directed fluid therapy are associated with significant reductions in postoperative cardiac arrhythmias.

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Authors and Affiliations

  1. Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Adam C. Fields MD, Beatrice Dionigi MD, Rebecca E. Scully MD MPH, Luisa Maldonado BS, Antonia Henry MD MPH, Joel E. Goldberg MD MPH & Ronald Bleday MD

  2. Department of Anesthesia, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Matthias F. Stopfkuchen-Evans MD

Authors
  1. Adam C. Fields MD
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  2. Beatrice Dionigi MD
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  3. Rebecca E. Scully MD MPH
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  4. Matthias F. Stopfkuchen-Evans MD
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  5. Luisa Maldonado BS
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  6. Antonia Henry MD MPH
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  7. Joel E. Goldberg MD MPH
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  8. Ronald Bleday MD
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Contributions

All authors had substantial contributions to the design of the work, drafted the work, made the final approval, and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Adam C. Fields MD.

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The study was reviewed and approved by the Institutional Review Board

Conflict of Interest

The authors declare that they have no conflict of interest.

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Fields, A.C., Dionigi, B., Scully, R.E. et al. Reduction in Cardiac Arrhythmias Within an Enhanced Recovery After Surgery Program in Colorectal Surgery. J Gastrointest Surg 24, 1158–1164 (2020). https://doi.org/10.1007/s11605-019-04298-7

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  • DOI: https://doi.org/10.1007/s11605-019-04298-7

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