{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:48:22Z","timestamp":1793836102897,"version":"4.6.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Innovationsausschuss in the Gemeinsamer Bundesausschuss","award":["01NVF19028"],"award-info":[{"award-number":["01NVF19028"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Enhanced recovery after surgery (ERAS) protocols are patient-centred, interprofessional perioperative care models aimed at reducing hospital stays, complications, healthcare costs, and improving patient satisfaction. Evidence for ERAS in cardiac surgery is scarce; therefore, we aimed to assess its efficacy and safety in minimally invasive heart valve surgery (MIHS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Interdisciplinary Perioperative Care in Minimally Invasive Heart Valve Surgery (INCREASE) is a randomized-controlled trial that compares ERAS with standard care in MIHS. The intervention group (IG) received ERAS-based treatment; the control group (CG) standard care. Co-primary end-points were in-hospital stay for cardiovascular reasons within 1 year postoperatively (superiority hypothesis) and physical performance (6-minute walk test [6MWT]) at discharge (non-inferiority hypothesis). Superiority hypothesis was tested primarily in surgically treated patients (modified intention to treat population), while non-inferiority hypothesis was tested in per protocol population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 201 patients scheduled for MIHS were randomized (IG: 101; CG: 100). Total weighted in-hospital stay within 1 year was non-significantly shorter in the IG (adjusted mean difference \u22122.7 days, 95% confidence interval (CI) (\u22126.3, 0.9), 1-sided P\u2009=\u2009.07). Sensitivity analyses favoured the IG (adjusted ratio 0.71, 95% CI, 0.6, 0.85). For 6MWT, adjusted mean difference was \u221214%, 95% CI (\u221243%, 15%) exceeding the non-inferiority margin of \u221215% (1-sided P\u2009=\u2009.48). Without baseline adjustment, 6MWT values revealed a mean difference between groups of \u22121%, 95% CI (\u221210%, 8%), reaching non-inferiority of the IG. Safety outcomes were comparable with the exception of an unexpected higher rate of post-operative atrial fibrillation in patients randomized to ERAS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ERAS is feasible and safe in MIHS. The trial did not demonstrate a reduction in length of hospital stay during the first postoperative year in the population studied. Exploratory analyses suggest that further evaluation of ERAS concepts is justified.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag061","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:11:14Z","timestamp":1769515874000},"source":"Crossref","is-referenced-by-count":3,"title":["Interdisciplinary and Cross-Sectoral Perioperative Care Model in Cardiac Surgery: ERAS Implementation in the Setting of Minimally Invasive Heart Valve Surgery (INCREASE)\u2014Results of a Randomized Controlled Trial"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3415-3385","authenticated-orcid":false,"given":"Johannes","family":"Petersen","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf , Hamburg 20251,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site North 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