Background: Enhanced Recovery After Surgery (ERAS) protocols have been implemented in various surgical specialties to improve patient outcomes and reduce opioid consumption. In cardiac surgery, the traditionally high-dose opioid use is associated with prolonged ventilation, intensive care unit (ICU) stays, and opioid-related adverse drug events (ORADEs). This study evaluates the impact of an ERAS^® Society-certified program on opioid consumption in patients undergoing elective cardiac surgery at Lausanne University Hospital. Methods: A retrospective, monocentric observational study was conducted comparing two patient cohorts: one treated with ERAS protocols (2023–2024) and a retrospective control group from 2019. Data were collected from the hospital’s electronic medical records and the ERAS program database. The primary outcome was total opioid consumption, measured intraoperatively and postoperatively (postoperative day (POD) 0–3). Secondary outcomes included pain control, length of stay, complications, and recovery parameters. Statistical analyses included multivariate logistic regression to identify factors associated with reduced opioid consumption. Results: Patients in the ERAS group demonstrated significantly lower total opioid consumption, whether intraoperatively (median sufentanil: 40 mcg vs. 51 mcg, p < 0.0001) or postoperatively (POD 0–3: p < 0.001). The ERAS group had faster extubation times, earlier mobilization and pain control with non-opioid analgesics, fewer complications, and shorter hospital stays (9 vs. 12 days, p < 0.001). Logistic regression identified fast-track extubation and absence of complications as strong predictors of reduced opioid use. Conclusions: The implementation of an ERAS protocol in cardiac surgery significantly reduces opioid consumption while enhancing recovery.

Aims : Mechanical alterations in patients with electrical conduction abnormalities are reported to have prognostic value in patients with left ventricular asynchrony or long QT syndrome beyond electrocardiogram (ECG) variables. Whether conduction and repolarization patterns derived from ECG are associated with speckle tracking echocardiography parameters in subjects without overt cardiac disease is yet to be investigated. To report ranges of longitudinal deformation according to conduction and repolarization values in a population-based cohort. Methods and results : One thousand, one hundred, and forty subjects (48.6 ± 14.0 years, 47.7% men) enrolled in the fourth visit of the STANISLAS cohort (Lorraine, France) were studied. Echocardiography strain was performed in all subjects. RR, PR, QRS, and QT intervals were retrieved from digitalized 12-lead ECG. Echocardiographic data were stratified according to quartiles of QRS and QTc duration values. Full-wall global longitudinal strain (GLS) was −21.1 ± 2.5% with a mechanical dispersion (MD) value of 34 ± 12 ms. Absolute GLS value was lower in the longest QRS quartile and shortest QTc quartile (both P < 0.001). Time-to-peak of strain was not significantly different according to QRS duration although significantly higher in patients with higher QTc (P < 0.001). MD was significantly greater in patients with longer QTc (32 ± 12 ms for QTc < 396 ms vs. 36 ± 12 ms for QTc > 421 ms; P = 0.002). Conclusion : Longer QTc is related to increased MD and better longitudinal strain values. In a population-based setting, QRS is not associated with MD, suggesting that echocardiography-based dyssynchrony does not largely overlap with ECG-based dyssynchrony.

OBJECTIVES: Enhanced recovery after surgery (ERAS) is a multidisciplinary, patient-centred approach aimed at expediting recovery, improving clinical outcomes, and reducing healthcare costs. Initially developed for colorectal surgery, ERAS principles have been successfully applied across various surgical specialties, including cardiac surgery. This study outlines the implementation and certification process of the ERAS program in a tertiary cardiac surgical centre within the Heart-Vessel Department at Lausanne University Hospital. METHODS: The implementation involved forming a multidisciplinary team, including cardiac surgeons, anaesthesiologists, intensivists, a cardiologist, clinical nurse specialists and physiotherapists. The ERAS nurse coordinator played a central role in organizing meetings, promoting the program, developing protocols, and collecting data. The certification process required adherence to ERAS guidelines, structured training and external evaluation. Key phases included pre-ERAS data collection, protocol dissemination, inclusion of the 1st patients, followed by analysis and full implementation. RESULTS: Achieving certification required maintaining a compliance rate of over 70% with established protocols. The process involved overcoming various barriers, such as inconsistent practices and the need for multidisciplinary collaboration. In this paper, we provide some solutions to these challenges, including team education, regular meetings and continuous feedback loops. Preliminary data from the initial cohort showed improvements in early mobilization, opioid use, respiratory complications and shorter hospital stays. CONCLUSIONS: The successful implementation of the ERAS program at our institution demonstrates the feasibility and benefits of a structured, multidisciplinary approach in cardiac surgery. Continuous self-assessment and adherence to guidelines are essential for sustained improvement in patient outcomes and healthcare efficiency.

Background: To evaluate the clinical impact of enhanced recovery after surgery (ERAS) protocols implementation in the cardiac surgery department at Lausanne University Hospital (CHUV) comparing outcomes between a prospective ERAS cohort and a retrospective cohort from 2019. Patients and Methods: A prospective cohort of 228 patients undergoing elective cardiac surgery with ERAS protocols between May 2023 and August 2024 was compared to a retrospective cohort of 162 patients from 2019. Inclusion criteria included on‐pump adult elective cardiac surgery patients via median sternotomy. Propensity score matching was applied based on six variables: age, sex, EuroSCORE II, type of surgery, previous cardiac surgery, and cardiopulmonary by‐pass duration, resulting in two matched groups of 125 patients each. Results: After matching, the ERAS group showed a significant reduction in median hospital length of stay from 11.0 to 9.0 days ( p = 0.002). The proportion of patients free from any of the defined complications increased in the ERAS group from 43.2% to 61.7% ( p = 0.006), indicating an overall reduction in postoperative morbidity. ERAS implementation independently increased odds of being complication‐free (OR 2.88 and p < 0.001). Opioid use on postoperative day 2 decreased from 9.90 to 3.30 morphine milligram equivalents (MME) ( p < 0.001) and mobilization rates on postoperative day 1 improved from 65.3% to 81.4% ( p = 0.048). Conclusions: ERAS protocols implementation in cardiac surgery at CHUV resulted in reduced hospital length of stay, decreased opioid use, improved early mobilization, and a lower overall complication rate. These findings demonstrate the effectiveness of adapting international ERAS guidelines to local practices in cardiac surgery.

Background/Objectives: Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery and is associated with increased morbidity and prolonged recovery. This study aimed to evaluate the impact of an enhanced recovery after surgery (ERAS) program on the incidence of POAF and broader perioperative outcomes. Methods: In this monocentric, observational cohort study, we compared a retrospective pre-ERAS cohort (n = 162) with a prospective ERAS cohort (n = 321). The primary outcome was the incidence of POAF, assessed using two definitions: (1) the American Association for Thoracic Surgery (AATS) 2014 clinical definition, identifying POAF as atrial fibrillation requiring treatment; and (2) the European Society of Cardiology (ESC) 2024 definition, describing new-onset atrial fibrillation occurring immediately after surgery. Secondary outcomes included compliance with POAF prophylaxis measures, length of hospital stay, and the occurrence of postoperative complications. Statistical analyses included propensity score matching and multivariate logistic regression to identify independent predictors of POAF. Results: ERAS implementation was associated with a significant reduction in POAF incidence across both definitions. According to the AATS 2014 definition, POAF occurred in 20% of ERAS patients vs. 39% in the pre-ERAS group (p = 0.001), and 23% vs. 39% in the matched cohort (p = 0.004). Using the ESC 2024 definition, POAF was observed in 21% vs. 37% (p = 0.001) in unmatched and 20% vs. 36% (p = 0.005) in matched populations. Compliance with POAF prophylaxis improved markedly in the ERAS group (70% vs. 21%, p = 0.001). ERAS patients also experienced shorter hospital stays and fewer postoperative complications (26% vs. 38% in the matched cohort, p = 0.033). Conclusions: The implementation of a structured ERAS protocol significantly reduced POAF incidence, improved compliance with preventive strategies, and enhanced key aspects of postoperative recovery.