The 10 Commandments of ERAS for Cardiac Surgery

Enhanced recovery after surgery (ERAS) is a term encompassing a set of strategies and practices aimed at reducing the surgical stress response and optimizing patient recovery through an evidence-based, multidisciplinary approach. The concept of ERAS was conceived by Henrik Kehlet, a Danish colorectal surgeon, in 1997. In a landmark paper, “Multimodal approach to control postoperative pathophysiology and rehabilitation” from 1997, Kehlet postulated that the physiologic response to surgery, which contributes to postoperative morbidity, can be mitigated using evidence-based, standardized care bundles.¹ While initially focused on colorectal surgery, the application of ERAS has now been demonstrated to improve outcomes in a wide array of surgical specialties.

The newest specialty to adopt ERAS practices is cardiac surgery. Since the first US-based cardiac ERAS program was implemented in 2017,² numerous programs have emerged across the United States. The international nonprofit ERAS Cardiac Society was formed in 2017 and subsequently published guidelines for what should be included in an ERAS cardiac program.³ These guidelines recommend 22 evidence-based care bundles for cardiac surgery. In addition to implementation of these bundles, the creation of a cardiac ERAS program involves pivoting the culture of care to a standardized, patient-centered philosophy with rigorous auditing and benchmarking. Adherence to several guiding principles described below is essential to build a successful cardiac ERAS program and improve outcomes.