{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T21:41:47Z","timestamp":1788903707228,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Enhanced recovery after surgery (ERAS) protocols aim to improve clinical outcomes, shorten hospital length of stay (LOS), and reduce costs through a multidisciplinary perioperative approach. Although introduced in colorectal surgery, they are less established in cardiac surgery, especially in combination with on-table extubation (OTE). This study evaluates the impact of a novel ERAS concept with OTE (RERACS) in elective aortic-valve-replacement and coronary bypass surgery. Methods: In a monocentric study, we compared a prospective RERACS-group (n = 114) to a retrospective control group (n = 119) (TRIAL Registration (DRKS00031402). The RERACS concept contained multiple perioperative treatment measures such as respiratory training, short fasting, and OTE. The control group received standard care. Results: Primary endpoint: postoperative LOS. Secondary measurements: length of postoperative vasoactive drug support, duration of mechanical ventilation, complication rate, and patient satisfaction on the second postoperative day. RERACS patients showed significantly shorter postoperative length of stay (ICU: 40 \u00b1 34 h vs. 56 \u00b1 51 h, p = 0.005; hospital: 9 \u00b1 4 d vs. 11 \u00b1 6 d, p = 0.028), lower nosocomial infection rates (24% vs. 40%), fewer cases of postoperative cognitive dysfunction ((subsyndromal) delirium 40% vs. 57%), reduced nausea and vomiting (14.9% vs. 32.8%), and faster weaning from catecholamines (22 \u00b1 30 h vs. 42 \u00b1 48 h, p &lt; 0.001), as well as high patient satisfaction. Conclusions: Our study indicated that an ERAS concept with OTE is safe and associated with faster and improved recovery, including lower catecholamine requirements, reduced LOS, and high patient satisfaction in low-risk cardiac surgery.<\/jats:p>","DOI":"10.3390\/jcm14020352","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T11:56:22Z","timestamp":1736337382000},"page":"352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Effects of Implementing an Enhanced Recovery After Cardiac Surgery Protocol with On-Table Extubation on Patient Outcome and Satisfaction\u2014A Before\u2013After Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4673-2003","authenticated-orcid":false,"given":"Adelina","family":"Werner","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Conrads","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Rosenberger","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Creutzenberg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Graf","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maik","family":"Foltan","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Blecha","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Stadlbauer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Floerchinger","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Tafelmeier","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Arzt","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christof","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3080-9957","authenticated-orcid":false,"given":"Diane","family":"Bitzinger","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Baehner, T., Pruemm, P., Vergnat, M., Asfour, B., Stra\u00dfberger-Nerschbach, N., Kirfel, A., Hamann, M., Mayr, A., Schindler, E., and Velten, M. (2022). Effects of on-Table Extubation after Pediatric Cardiac Surgery. J. Clin. Med., 11.","DOI":"10.3390\/jcm11175186"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Dencker, E.E., Bonde, A., Troelsen, A., Varadarajan, K.M., and Sillesen, M. (2021). Postoperative complications: An observational study of trends in the United States from 2012 to 2018. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01392-z"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1089\/lap.2017.0350","article-title":"The History of Enhanced Recovery After Surgery and the ERAS Society","volume":"27","author":"Ljungqvist","year":"2017","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ljungqvist, O., Francis, N.K., and Urman, R.D. (2020). Enhanced Recovery After Surgery: A Complete Guide to Optimizing Outcomes, Springer.","DOI":"10.1007\/978-3-030-33443-7"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1001\/jamasurg.2019.1153","article-title":"Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations","volume":"154","author":"Engelman","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101059","DOI":"10.1016\/j.accpm.2022.101059","article-title":"Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump","volume":"41","author":"Mertes","year":"2022","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.athoracsur.2023.12.006","article-title":"Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS)","volume":"117","author":"Grant","year":"2024","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3101","DOI":"10.1016\/j.jtcvs.2014.07.037","article-title":"Extubating in the operating room after adult cardiac surgery safely improves outcomes and lowers costs","volume":"148","author":"Badhwar","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","first-page":"39","article-title":"Can timing of tracheal extubation predict improved outcomes after cardiac surgery?","volume":"1","author":"Camp","year":"2009","journal-title":"HSR Proc. Intensive Care Cardiovasc. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Werner, A.S., Foltan, M., Creutzenberg, M., Graf, B.M., Stadlbauer, A., Tafelmeier, M., Arzt, M., Floerchinger, B., Schmid, C., and Bitzinger, D. Does an Enhanced Recovery After Cardiac Surgery Protocol with On-Table Extubation Improve Patient Outcome and Satisfaction?. J. Cardiothorac. Vasc. Anesth., 2024, Online ahead of print.","DOI":"10.1053\/j.jvca.2024.11.002"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"445S","DOI":"10.1378\/chest.120.6_suppl.445S","article-title":"Trials comparing early vs late extubation following cardiovascular surgery","volume":"120","author":"Meade","year":"2001","journal-title":"Chest"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s001340100909","article-title":"Intensive Care Delirium Screening Checklist: Evaluation of a new screening tool","volume":"27","author":"Bergeron","year":"2001","journal-title":"Intensive Care Med."},{"key":"ref_13","first-page":"442","article-title":"Steigerung der an\u00e4sthesiologischen Ergebnisqualit\u00e4t durch standardisierte Patientenbefragung. Enhancing the quality of anaesthesiological results with standardised patient surveys","volume":"63","author":"Messroghli","year":"2022","journal-title":"An\u00e4sth. Intensiv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1177\/2047487317752373","article-title":"The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis","volume":"25","author":"Marmelo","year":"2018","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1177\/0269215513516475","article-title":"Prehabilitation program for elective coronary artery bypass graft surgery patients: A pilot randomized controlled study","volume":"28","author":"Sawatzky","year":"2014","journal-title":"Clin. Rehabil."},{"key":"ref_16","unstructured":"Bellgardt, M., B\u00fcrkle, H., Heymann, A., Horter, J., Kleinschmidt, S., M\u00fcller, A., M\u00fcller-Brandes, C., Putensen, C., Spies, C., and Schallner, N. (2024, September 29). Leitlinie Analgesie, Sedierung und Delirmanagement in der Intensivmedizin (DAS-Leitlinie 2020) 2020, 1\u201312. Available online: https:\/\/register.awmf.org\/assets\/guidelines\/001-012l_S3_Analgesie-Sedierung-Delirmanagement-in-der-Intensivmedizin-DAS_2021-08.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.bpa.2009.08.004","article-title":"Modulating postoperative insulin resistance by preoperative carbohydrate loading","volume":"23","author":"Ljungqvist","year":"2009","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1111\/j.1399-6576.2008.01660.x","article-title":"Pre-operative oral carbohydrate treatment before coronary artery bypass surgery","volume":"52","author":"Maaranen","year":"2008","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_19","first-page":"119","article-title":"Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery","volume":"52","author":"Barker","year":"2009","journal-title":"Can. J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/ACO.0000000000000061","article-title":"Delirium in the cardiac surgical ICU","volume":"27","author":"Brown","year":"2014","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"128","DOI":"10.5603\/AIT.a2018.0011","article-title":"ICU delirium\u2014A diagnostic and therapeutic challenge in the intensive care unit","volume":"50","author":"Kotfis","year":"2018","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/j.jtcvs.2005.06.050","article-title":"Risk factors for and economic implications of prolonged ventilation after cardiac surgery","volume":"130","author":"Rajakaruna","year":"2005","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/ALN.0b013e31817881b3","article-title":"Cardiac surgery fast-track treatment in a postanesthetic care unit: Six-month results of the Leipzig fast-track concept","volume":"109","author":"Ender","year":"2008","journal-title":"Anesthesiology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s00423-013-1151-9","article-title":"Fast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma","volume":"399","author":"Jia","year":"2014","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/EJA.0000000000001131","article-title":"Dexmedetomidine versus propofol sedation in reducing delirium among older adults in the ICU: A systematic review and meta-analysis","volume":"37","author":"Pereira","year":"2020","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/oxfordjournals.bja.a013383","article-title":"Patient satisfaction after anaesthesia and surgery: Results of a prospective survey of 10,811 patients","volume":"84","author":"Myles","year":"2000","journal-title":"Br. J. Anaesth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1093\/bja\/77.3.356","article-title":"Nausea and vomiting after cardiac surgery","volume":"77","author":"Grebenik","year":"1996","journal-title":"Br. J. Anaesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/aca.ACA_122_17","article-title":"Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study","volume":"21","author":"Champion","year":"2018","journal-title":"Ann. Card. Anaesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.2147\/JPR.S162067","article-title":"Assessment and pathophysiology of pain in cardiac surgery","volume":"11","author":"Zubrzycki","year":"2018","journal-title":"J. Pain Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1053\/j.jvca.2018.05.053","article-title":"Opioid-Based Anesthesia and Analgesia for Adult Cardiac Surgery: History and Narrative Review of the Literature","volume":"33","author":"Kwanten","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Paul, A.K., Smith, C.M., Rahmatullah, M., Nissapatorn, V., Wilairatana, P., Spetea, M., Gueven, N., and Dietis, N. (2021). Opioid Analgesia and Opioid-Induced Adverse Effects: A Review. Pharmaceuticals, 14.","DOI":"10.3390\/ph14111091"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.ccc.2020.06.003","article-title":"Postoperative Multimodal Analgesia in Cardiac Surgery","volume":"36","author":"Barr","year":"2020","journal-title":"Crit. Care Clin."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.athoracsur.2020.07.074","article-title":"Vocal Fold Mobility Impairment After Cardiovascular Surgery: Incidence, Risk Factors, and Sequela","volume":"112","author":"Plowman","year":"2021","journal-title":"Ann. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/352\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:25:10Z","timestamp":1759919110000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,8]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020352"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020352","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,8]]}}}