Perioperative Optimization of the Cardiac Surgical Patient

• Published in: Canadian journal of cardiology 2023-04, Vol.39 (4), p.497-514
• Main Authors: Gregory, Alexander J., Noss, Christopher D., Chun, Rosaleen, Gysel, Michael, Prusinkiewicz, Christopher, Webb, Nicole, Raymond, Meggie, Cogan, Jennifer, Rousseau-Saine, Nicolas, Lam, Wing, van Rensburg, Gerry, Alli, Ahmad, de Vasconcelos Papa, Fábio
• Format: Article
• Language: English
• Subjects: Cardiac Surgical Procedures; Delivery of Health Care; Humans; Patients; Perioperative Care; Quality of Life
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2023.01.032

Perioperative optimization of cardiac surgical patients is imperative to reduce complications, utilize health care resources efficiently, and improve patient recovery and quality of life. Standardized application of evidence-based best practices can lead to better outcomes. Although many practices should be applied universally to all patients, there are also opportunities along the surgical journey to identify patients who will benefit from additional interventions that will further ameliorate their recovery. Enhanced recovery programs aim to bundle several process elements in a standardized fashion to optimize outcomes after cardiac surgery. A foundational concept of enhanced recovery is attaining a better postsurgical end point for patients, in less time, through achievement and maintenance in their greatest possible physiologic, functional, and psychological state. Perioperative optimization is a broad topic, spanning multiple phases of care and involving a variety of medical specialties and nonphysician health care providers. In this review we highlight a variety of perioperative care topics, in which a comprehensive approach to patient care can lead to improved results for patients, providers, and the health care system. A particular focus on patient-centred care is included. Although existing evidence supports all of the elements reviewed, most require further improvements in implementation, as well as additional research, before their full potential and usefulness can be determined. L’optimisation périopératoire de l’état des patients subissant une chirurgie cardiaque est nécessaire pour diminuer le risque de complications, utiliser efficacement les ressources de soins de santé, et améliorer le rétablissement des patients ainsi que leur qualité de vie. L’application normalisée de pratiques exemplaires fondées selon des données probantes pourrait entraîner des résultats plus favorables. Même si plusieurs mesures devraient idéalement être appliquées de façon universelle à tous les patients, il est également possible tout au long de leur parcours, de cibler ceux qui bénéficieraient d’interventions supplémentaires permettant d’aider davantage à leur rétablissement. Les programmes mis en œuvre à cet effet après une intervention chirurgicale visent à regrouper plusieurs éléments au sein d’une approche normalisée de façon à optimiser les résultats. L’un des concepts de base pour améliorer le rétablissement consiste à accélérer l’obtention des meilleurs rés