| Title: |
Enhanced recovery after surgery in minimally invasive heart valve surgery - insights from the INCREASE trial |
| Authors: |
Girdauskas, E; Petersen, J; Stock, S; Vettorazzi, E; Ozga, A K; Zapf, A; Brettschneider, C; Dolata, L; Loewe, B; Schmid, M; Schulte-Uentrop, L; Dumps, C; Zastrow, I; Reichenspurner, H; Klotz, S |
| Source: |
European Heart Journal ; volume 46, issue Supplement_1 ; ISSN 0195-668X 1522-9645 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2025 |
| Description: |
Background Enhanced recovery after surgery (ERAS) protocols are patient-centered and interprofessional perioperative care models, aiming to reduce hospital stay, complications, and to improve patient satisfaction. However, in cardiac surgery, the evidence for ERAS is low. Purpose The INCREASE trial aims to evaluate the efficacy and the safety of ERAS-based intervention in cardiac surgery. Methods The INCREASE trial is a randomized, parallel, two-arm trial designed to compare the ERAS protocol with standard of care in minimally invasive heart valve surgery. The trial was conducted in an interprofessional consortium consisting of 2 university hospitals, 7 referring hospitals, 8 rehabilitation centers, a health insurance company and a patient organization. The intervention group (IG) received treatment according to the standardized ERAS protocol, which included prehabilitation, early extubation, and modifications in the postoperative care e.g., physiotherapy beginning at 3hours postoperatively. The control group (CG) received treatment as usual. Two co-primary endpoints were considered: a) in-hospital stay (days) within 1 year after surgery due to cardiac causes (superiority hypothesis), b) physical performance measured by 6-minute walk test (6MWT) at hospital discharge (non-inferiority hypothesis). Primary outcome analysis included only surgically treated patients (modified intention to treat (mITT) population). Results 201 patients (mean age 57±13 years, 72% male) scheduled for minimally invasive valve surgery were randomized into IG (n=101) and CG (n=100) between 09/2021 and 05/2023. 190 patients (93 IG vs. 97 CG) served as mITT population. Total weighted in-hospital stay (weights= individual study duration) within 1 year after surgery due to cardiac causes was 9.0±11.6 days in the IG and 11.7±13.1 days in the CG (adjusted mean difference -2.7, 95%CI (-6.3, 0.9), p=0.07). Sensitivity analyses using the negative binomial model revealed an adjusted ratio of 0.71, 95% CI (0.6, 0.85), p |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/eurheartj/ehaf784.3312 |
| Availability: |
https://doi.org/10.1093/eurheartj/ehaf784.3312; https://academic.oup.com/eurheartj/article-pdf/46/Supplement_1/ehaf784.3312/65187862/ehaf784.3312.pdf |
| Rights: |
https://academic.oup.com/pages/standard-publication-reuse-rights |
| Accession Number: |
edsbas.6C6D0864 |
| Database: |
BASE |