Team Approach Improves Recovery after Cardiothoracic Surgery

Rakesh C. Arora, MD

Rakesh C. Arora, MD

State-of-the-art strategies for recovery after cardiothoracic surgery are changing. The latest enhanced recovery protocols (ERP) rely on a multidisciplinary team approach that includes surgeons, anesthesiologists, intensivists, and other specialists to minimize trauma during surgery while maximizing safety, outcomes, and value.

“ERP is a process of care that is as disruptive to our field as transcatheter aortic valve replacement has been,” said Rakesh C. Arora, MD, from the University of Manitoba in Winnipeg, Canada, who will moderate a Sunday morning session planned by STS and the Society of Cardiovascular Anesthesiologists (SCA). “When we have teams focusing on perioperative outcomes and improving the patient journey, it can have a substantial impact on the trajectory of patients who normally may not thrive after an operation.

Surgeons still need to select the right patient for the right procedure and deliver a technically perfect operation, Dr. Arora noted. But surgical skill alone is not sufficient. 

STS/SCA: Cardiac and Thoracic Enhanced Recovery after Surgery

10:00 a.m. – 12:00 p.m.
Room 220

“The other team members are similarly important in ERP,” he said. “It is not just surgery; it is a bundle of care that includes surgery and all of the other services that contribute to patients and their outcomes.”

Part of that team approach has both surgeons and anesthesiologists taking more proactive roles in setting patient expectations, said Stanton K. Shernan, MD, from Harvard Medical School and Brigham and Women’s Hospital in Boston, who also will moderate the STS/SCA session. Analgesic agents have been a significant cause of postoperative morbidity in the past. Improving outcomes by minimizing the potential for analgesia-associated morbidity means reducing the use of narcotics and substituting local blocks for general anesthesia where possible. 

“Having no pain whatsoever during surgery shouldn’t be the goal,” Dr. Shernan explained. “Instead, it’s a tradeoff—less-than-perfect analgesia for being able to go home sooner with fewer complications. That kind of mental preparation begins before surgery when both the surgeon and the anesthesiologist talk with the patient. We are changing the ways we manage patients so that they leave the hospital with the same expectations of recovery but perhaps a higher level of safety.”