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Enhanced Recovery After Cardiac Surgery: Gender Insights From an Ultra-Fast-Track Protocol

Year: 2026

Type: article

Abstract: OBJECTIVES: Ultra-fast-track (UFT) enhanced recovery after surgery (ERAS)-defined by on-table extubation, minimally invasive surgical technique and de-escalated ICU care-represents an intensified ERAS approach. Female patients remain under-represented in cardiac surgery research and experience worse postoperative outcomes. Therefore, we investigated possible gender-mediated differences in the outcomes of our UFT-ERAS program. METHODS: A total of 800 consecutive patients underwent UFT-ERAS for minimally invasive valve and aortic surgery at our institution from 01/2021 to 09/2024. Patients were divided by gender, and a retrospective cohort analysis was performed. The primary outcome was UFT-ERAS achievement, defined by a 0-5 score of postoperative milestones (on-table extubation, postoperative intermediate care, early physiotherapy, transfer to the general ward ≤24 h and hospital discharge ≤7 days). Secondary end points were major adverse cardiovascular events (MACE), reoperation for bleeding, reintubation, ICU readmission, acute kidney injury, atrial fibrillation, delirium and transfusion. RESULTS: Women were older and had higher baseline risk scores. Overall, ERAS adherence and major postoperative complications were comparable between the sexes. Only discharge ≤7 days was less frequent, and postoperative transfusion need more frequent in women. In multivariable ordinal logistic regression adjusting for STS-PROM, age, and procedure type, sex was not independently associated with ERAS achievement (OR 0.88, 95% CI, 0.66-1.18). CONCLUSIONS: In this predominantly low-risk patient cohort within a UFT-ERAS pathway, sex was not independently associated with overall ERAS achievement. However, women more frequently required transfusion and were less likely to be discharged within 7 days.

Source: Interdisciplinary CardioVascular and Thoracic Surgery

DOI: 10.1093/icvts/ivag105