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.

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: Anemia is a common condition in cardiac surgery and is strongly associated with adverse outcomes, including higher transfusion requirements, increased morbidity, and prolonged hospital stay. Enhanced Recovery After Surgery (ERAS) and Patient Blood Management (PBM) are both multimodal strategies designed to improve perioperative care. This study evaluates the impact of integrating ERAS and PBM with preoperative anemia management into a single standardized pathway in elective cardiac surgery. Methods: We conducted a retrospective, single-center before–after study at Lausanne University Hospital, comparing a pre-ERAS cohort (2019) with a prospective cohort managed under the ERAS–PBM pathway (May 2023–November 2024). The ERAS–PBM pathway included systematic preoperative anemia screening and treatment, reinforcement of adherence to existing restrictive transfusion thresholds, optimized blood conservation techniques, and standardized perioperative care bundles coordinated by a dedicated ERAS nurse. The primary outcome was the rate of red blood cell (RBC) transfusions during hospitalization. Secondary outcomes included overall transfusion rates, hemoglobin levels, complications, and length of stay. Results: A total of 391 patients were included (ERAS, n = 229; pre-ERAS, n = 162). RBC transfusion rates were significantly lower in the ERAS group (23.6% vs. 38.9%, p = 0.0012), with a reduction in the number of units per patient (p = 0.0005). Hemoglobin at admission was higher in the ERAS cohort (139.5 vs. 134 g/L, p = 0.0009). Overall complication rates decreased (46.3% vs. 66.7%, p < 0.0001), including major adverse cardiovascular events and pulmonary complications. Hospital stay was shorter (9 vs. 12 days, p < 0.0001), as was mechanical ventilation time (0 vs. 2.1 h, p < 0.0001). Anemic patients at admission were more transfused (39.3% vs. 18.6%, p = 0.002). Within the ERAS group, RBC transfusion was associated with higher rates of selected postoperative complications and longer ICU and hospital stays. In an exploratory multivariable logistic regression analysis, ERAS–PBM implementation was associated with lower odds of RBC transfusion during hospitalization (adjusted OR 0.59, 95% CI 0.36–0.98; p = 0.041). Conclusions: The integration of ERAS and PBM into a single multimodal pathway was associated with significant reductions in transfusion rates, complications, and length of stay in elective cardiac surgery. Anemia at admission and perioperative transfusion were associated with worse outcomes, emphasizing the importance of anemia management. Larger, multicenter prospective studies are warranted to confirm these results and to optimize anemia correction strategies, including earlier treatment of iron deficiency and outpatient erythropoietin use.