LAUSR

INTRODUCTION We sought to develop and implement a comprehensive enhanced recovery after surgery (ERAS) protocol for patients implanted with a left ventricular assist device (LVAD). METHODS In this manuscript we describe our approach to the development and phased implementation of the protocol.  Additionally, we reviewed prospectively collected data for patients who underwent LVAD implantation at our institution from February 2019 to August 2020. In order to compare early outcomes in our patients before and after protocol implementation, we dichotomized patients into two 6- month cohorts (Pre-ERAS and ERAS cohorts) separated from each other by 6 months to allow for staff adoption of the protocol. RESULTS Of the 115 LVAD implants, 38 patients were implanted in Pre-ERAS period and 46 patients in ERAS cohort period. Preoperatively, the patients` characteristics were similar between the cohorts. Postoperatively, we observed reduction in bleeding (chest tube output: 1006 vs 647.5, ml, p<0.001), and blood transfusions (Fresh frozen plasma: 31.6% vs 6.7%, p=0.04; Platelets: 42.1% vs 8.7%, p=0.001). Opioid prescription at discharge were 5-fold lower with the ERAS approach (p<0.01). Furthermore, the number of patients discharged to rehab significantly decreased (20.0% vs 2.4%, p=0.02). Index-hospitalization length of stay and survival were similar between the groups. CONCLUSION ERAS for patients undergoing LVAD implantation is a novel, evidence-based, interdisciplinary approach to care with multiple potential benefits. In this manuscript we described details of the protocol and early positive changes in clinical outcomes. Further studies are needed to evaluate benefits of an ERAS protocol in in LVAD population. LAY SUMMARY Enhanced Recovery After Surgery (ERAS) is the implementation of standardized clinical pathways that ensures utilization of best practices and reduces variation in perioperative care. Multidisciplinary teams work together on ERAS, thus also enhancing communication amongst healthcare silos. ERAS has been utilized for over 30 years by other surgical service lines and has been shown to lead to decreased, LOS, complications, mortality, readmissions, job satisfaction, and costs. Our goal was to translate these benefits to the perioperative care of complex LVAD patients. Early results suggest this is possible as we observed reduction in transfusions, discharge on opioids and discharge to rehabilitation.