Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations
Open accessAbstract
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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According to Enhanced Recovery After Surgery recommendations, perioperative nutritional optimization is key to expediting recovery.
“According to Enhanced Recovery After Surgery recommendations,186 perioperative nutritional optimization is key to expediting recovery.”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [186]
Albumin <3.0 g/dL and prealbumin ≤20 mg/dL have been used as acute-phase markers to trigger nutritional supplementation within 1 week of surgery, although they are not good markers of nutritional status.
“Although not good markers of nutritional status, albumin <3.0 g/dL and prealbumin ≤20 mg/dL have been used as acute-phase markers to trigger nutritional supplementation within 1 week of surgery.186,189–191”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [186]
The evidence for preoperative oral carbohydrate loading before cardiac surgery is weak.
“Although preoperative oral carbohydrate loading has been proposed to benefit cardiac function and may improve length of stay, its evidence before cardiac surgery is weak.186,194”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [186]
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References 204 · Cited by 1,225
- Authors
- Engelman, D. T., Ben Ali, W., Williams, J. B., Perrault, L. P., Reddy, V. S., Arora, R. C., Roselli, E. E., Khoynezhad, A., Gerdisch, M., Levy, J. H., Lobdell, K., Fletcher, N., Kirsch, M., Nelson, G., Engelman, R. M., Gregory, A. J., & Boyle, E. M.
- Affiliations
- Baystate Medical Center (US)
- Montreal Heart Institute, Montreal, Canada
- WakeMed (US)
- Montreal Heart Institute (CA)
- Centennial Medical Center (US)
- St. Boniface Hospital (CA)
- Cleveland Clinic (US)
- MemorialCare Heart and Vascular Institute, Los Angeles, California
- Franciscan Health Indianapolis (US)
- Duke University (US)
- Atrium Health, Department of Cardiovascular and Thoracic Surgery, North Carolina
- St George's, University of London (GB)
- Centre Hospitalier Universitaire Vaudois (CH)
- University of Calgary (CA)
- St. Charles Medical Center (US)
- Corresponding author
- Engelman, Daniel T.
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2019-08-01
- Volume
- 154
- Issue
- 8
- Pages
- 755
- ISSN
- 2168-6254 (ISSN-L)
- OpenAlex
- W2943204414
- Cited by
- 1,225
- References
- 204
- Citations by year
- 2026: 193 · 2025: 220 · 2024: 204 · 2023: 166 · 2022: 147 · 2021: 159 · 2020: 103 · 2019: 30 · 2018: 1
- FWCI
- 22.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Surgery (publishedVersion)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- enhanced recovery after surgery, perioperative care, cardiac surgery, consensus recommendations, evidence-based protocols, clinical outcomes, cost reduction
- MeSH terms
- Enhanced Recovery After Surgery, Cardiac Surgical Procedures, Humans, Practice Guidelines as Topic, Perioperative Care, Consensus
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