ERAS – Enhanced Recovery After Cardiac Surgery Society

September 28, 2021

Patient survey shows low level of understanding in key areas, and desire for more face-to-face time with clinicians

28 September 2021: ERAS Cardiac, a non-profit clinician-led organization focused on continuous improvement in patient outcomes, has today published new research providing insight into the experiences of heart surgery patients in the UK pre-procedure, during their time in hospital and post-discharge.

The research, conducted with 80 NHS patients who underwent cardiac surgery between 2016 and 2019, demonstrates a high rate of satisfaction (86 per cent) with the overall outcome of their surgery. 71 per cent of patients reported improvement in their physical health, 45 per cent in their mental health and 70 per cent in their overall quality of life.

The research also identified areas for improvement.

Better information provision

Patients were asked about the information provided to them pre-procedure, during their time in hospital and post-discharge. 68 per cent found the pre-procedure information very helpful, but that figure dropped to 55 per cent post-discharge. The research highlighted several areas of lower understanding.

A majority of patients (79 per cent) said they felt prepared for their procedure before they had it. Yet despite this, one third of respondents (34 per cent) did not feel they had a good understanding of the level of pain they could expect after their surgery.

69 per cent of patients felt they had a good understanding of the survival rate for heart surgery before their procedure. However, when asked to estimate the survival rate, only 29 per cent were able to correctly state that it is above 90 per cent. [1] While making such estimates can be difficult, this does suggest a knowledge gap.

Asked to consider their time in hospital, a quarter (27 per cent and 25 per cent respectively) did not feel they had a good understanding of the likely after-effects of general anaesthetic or the post-operative tests that would be necessary, and 29 per cent did not feel they had a good understanding of how long they would be kept in hospital before discharge.

After discharge from hospital, a third of patients (34 per cent) did not feel they had a good understanding of the level of pain they could expect during their recovery. A quarter of respondents (26 per cent) did not feel they had a good understanding of the support available to them during their recovery, and the same proportion (26 per cent) did not feel they had a good understanding of when they could return to everyday physical activities.

44 per cent of patients also indicated that they were worried beforehand about the burden of care on friends and family following their procedure, suggesting that resources for those closest to patients would also be welcomed. Other areas where patients felt they had lower understanding before they had their procedure include the medication they would be required to take afterwards (31 per cent did not feel they had a good understanding), the support that would be available after their procedure (30 per cent) and the length of time it would take to recover (29 per cent).

More face-to-face support

The survey results suggest that personal contact with healthcare professionals would be welcomed: 41 per cent of patients said they would have liked to have had a face-to-face meeting with a surgeon or nurse post-discharge. Notably, there was also an appetite for virtual meetings, as 39 per cent of patients surveyed said they would like to have had a virtual meeting with a surgeon, and 28 per cent would have liked one with a nurse.

Marjan Jahangiri MBBS MS FRCS(CTh), Professor of Cardiac Surgery at St. George's Hospital, University of London and member of the ERAS Cardiac Executive Board said: This is important research to help us better understand the experiences of patients undergoing heart surgery, and to identify ways in which we can improve the provision of care. While it is heartening to see high levels of satisfaction overall, it is concerning that many patients are still uncertain about critical information like the levels of pain they can expect, the support available to them and how long they will be kept in hospital. We must take this opportunity to review and enhance the information we provide, to reassure patients and better equip them to make a full recovery.

There is a clear desire for more face-to-face time with surgeons and surgical teams post-discharge. In addition, more and more patients are comfortable with virtual consultations, and with the aid of technology, we should take advantage of this to open up more ways for patients to access support.

Simon Kendall, Consultant Cardiac Surgeon and President of the Society for Cardiothoracic Surgery in Great Britain & Ireland (SCTS) said: SCTS strongly supports ERAS for cardiac surgery. Mounting evidence is gathering demonstrating surgical teams that implement ERAS improve patient outcomes, improve patient experience, decrease complications, decrease length of stay and improve the efficient use of their ITU and HDU beds. In turn, this also has the clear potential to reduce the awful scenario where patients are cancelled on the day of their surgery.

Dr. Bhuvaneswari Krishnamoorthy PhD, NTF, PFHEA, FFPCEd, National Nurses and Allied Health Professional (NAHP) Society of Cardiothoracic Surgery (SCTS) chair said: As a NAHP group we strongly believe in evidence based clinical practice and this patient survey has given us an insight into how patients feel about their recovery post cardiac surgery. As a surgical nurse, one of my concerns is patient postoperative recovery and pain. In the 21st century, CT surgery has moved towards minimally invasive and robotic surgery to reduce postoperative surgical pain and better recovery. One of our SCTS NAHP divisions aims is to develop an ERAS awareness course particularly designed for patients and multidisciplinary team members to ease the patients about their perioperative journey and enhance their confidence and send them back home safely from hospital.

Dr Niall OKeeffe, President of the Association for Cardiothoracic Anaesthesia and Critical Care, said: ACTACC strongly supports the concept of ERAS and believes better preparation of the cardiac surgical patient can have a positive impact on outcome. This would include improving the quality of the information provided to the patient, and also focusing on better patient conditioning and preparation where possible. This is a multidisciplinary process.

Karl Perry, a patient who underwent cardiac surgery in 2019, said: Its great to see such high levels of patient satisfaction, as the positive difference heart surgery can make to patients lives is statistically very clear. However, the difference between perception and reality means far too many people with heart conditions are still nervous about whether or not to go ahead with surgery. A poor understanding of what the operations involve and the risks associated with them, only add to this nervousness. I hope this research helps to reverse some of this poor understanding around heart surgery, so even more people get to enjoy longer and better quality lives with their loved ones.

[1] Overall mortality rates following cardiac surgery were 2.59% in 2018/19 according to the National Institute for Cardiovascular Outcomes Research (NICOR).

Media contacts

Ayesha Bharmal / Tom Parker Brooks, Brunswick Group +44 (0) 20 7404 5959

About the research

Total sample size was 80 patients who have undergone either elective or emergency heart surgery on the NHS between January 2016 and December 2019. Fieldwork was conducted between 18th December 2020 4th May 2021. The survey was carried out online. Respondents were recruited via two methods: a) an established patient research panel; and b) via the ERAS Cardiac Surgeon Network (surgeons belonging to the network shared the survey link with patients). It was commissioned by ERAS Cardiac and funded by one of ERAS Cardiacs corporate partners, Edwards Lifesciences. Full data available on request.

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ERAS - Enhanced Recovery After Cardiac Surgery Society