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Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery. A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews was conducted for each protocol element. The quality of the evidence was graded and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery After Surgery Society.
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Accepted for Publication: March 16, 2019.
Corresponding Author: Daniel T. Engelman, MD, Heart and Vascular Program, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199 (email@example.com).
Published Online: May 4, 2019. doi:10.1001/jamasurg.2019.1153
Author Contributions: Dr Engelman had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: D. Engelman, Williams, Perrault, Reddy, Arora, Roselli, Gerdisch, Lobdell, Fletcher, Kirsch, Nelson, Gregory, Boyle.
Acquisition, analysis, or interpretation of data: D. Engelman, Ben Ali, Williams, Perrault, Reddy, Arora, Khoynezhad, Levy, Lobdell, Fletcher, Nelson, R. Engelman.
Drafting of the manuscript: D. Engelman, Williams, Perrault, Arora, Khoynezhad, Gerdisch, Levy, Lobdell, Fletcher, R. Engelman, Boyle.
Critical revision of the manuscript for important intellectual content: D. Engelman, Ben Ali, Williams, Perrault, Reddy, Arora, Roselli, Gerdisch, Levy, Lobdell, Fletcher, Kirsch, Nelson, Gregory.
Statistical analysis: Ben Ali.
Administrative, technical, or material support: D. Engelman, Williams, Perrault, Reddy, Levy, Lobdell, R. Engelman, Boyle.
Supervision: D. Engelman, Perrault, Reddy, Fletcher, Nelson.
Conflict of Interest Disclosures: Dr Khoynezhad consults for and receives speaking honoraria from Atricure Inc. Dr Levy reported serving on research and steering committees for Boehringer-Ingelheim, CSL Behring, Octapharma, Instrumentation Labs, and Merck. Dr Perrault is on the scientific advisory board for ClearFlow Inc and a consultant and principal investigator for Somahlution. Dr Gerdisch is a consultant and principal investigator for and receives speaker honoraria from Zimmer Biomet and Cryolife and consults for and receives speaking honoraria from Atricure Inc. Dr Arora has received honoraria from Mallinckrodt Pharmaceuticals and an unrestricted education grant from Pfizer Canada. Dr R. Engelman is a consultant for Cryolife. Dr D. Engelman reported personal fees from Astute Medical, Edwards Lifescience, and Zimmer-Biomet outside the submitted work. Dr Reddy reports personal fees from Astute Medical outside the submitted work. Dr Arora reports grants from Pfizer Canada and honoraria from Mallickrodt Pharmaceuticals. Dr Roselli reports personal fees from Abbott, Edwards, LivaNova, and Cryolife and grants and personal fees from Gore, Medtronic, and TerumoAortic, outside the submitted work. Dr Boyle reports personal fees from ClearFlow Medical during the conduct of the study and is a founder of and has a patent to ClearFlow Medical pending and issued. No other disclosures were reported.
Disclaimer: The authors verify that all information and materials in this article are original, except for the Box, which is reprinted with permission.
Previous Presentation: American Association for Thoracic Surgery 98th Annual Meeting; April 28 and May 1, 2018; San Diego, California.
Additional Contributions: We thank Olle Ljungqvist, MD, PhD, Örebro University, for his support throughout this process and Gudrun Kunst, MD PhD, FRCA, FFICM, King’s College Hospital, and Michael Grant, MD, Johns Hopkins, for their review of the manuscript. They were not compensated.
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