Date of Award
2026
Keywords
enhanced recovery after surgery (ERAS), cardiac surgery, perioperative care, mechanical ventilation, intensive care unit, postoperative complications
Document Type
Thesis - ECU Access Only
Publisher
Edith Cowan University
Degree Name
Master of Nursing (Research)
School
School of Nursing and Midwifery
First Supervisor
Beverley Ewens 
0000-0003-2008-7214
Second Supervisor
Mandy Towell-Barnard 0000-0002-2475-7724
Third Supervisor
Vicki Patton 0000-0002-6721-0446
Abstract
Aims: To benchmark perioperative practices in adult cardiac surgery against the ERAS cardiac surgery recommendations, with the overarching goal of identifying areas of alignment and gaps in current practice.
Objectives: To determine the level of adherence to ERAS Cardiac Society evidence based Guidelines across preoperative, intraoperative, and postoperative phases in adult cardiac surgery.
Background: The Enhanced Recovery After Surgery (ERAS) Cardiac Society outlines perioperative strategies to optimise in adult cardiac surgical patients. Despite this, variation in practices persists. This study audited perioperative care at a tertiary hospital in Perth, Western Australia, benchmarked practices against ERAS guidelines, and explored associations with key clinical outcomes.
Methodology: A retrospective cohort analysis was conducted on adult cardiac patients who underwent cardiac surgery over a 12-month period. Compliance with selected ERAS recommendations was assessed across preoperative, intraoperative, and postoperative phases, focusing on optimisation strategies and ICU management. ERAS guidelines targets were used for benchmarking. Associations with mechanical ventilation time (< 6 vs > 6 hours), ICU and hospital length of stay, and major complications were explored. Descriptive statistics summarised cohort characteristics. Group comparisons used non-parametric tests (Mann-Whitney U, Kruskal-Wallis) and chi-square tests. Variables with significant associations were included in multivariable models: ordinal logistic regression for ventilation time and negative binomial regression for ICU and hospital stay.
Results: A total of 251 adult cardiac surgical patients were included in the audit. The median hospital stay was 7 days (IQR: 5-15), and ICU stay was 2 days (IQR:1-3). Only 41% of patients were extubated within 6 hours. Inconsistencies were noted in ERAS-related care, including fasting duration, substance cessation, and delirium screening. Atrial fibrillation, acute kidney injury, and respiratory complications were frequent. Prolonged mechanical ventilation, urgency of surgery, postoperative complications, and longer intraoperative times were linked with extended ICU and hospital stays.
Conclusion: This audit identified variability in alignment to ERAS recommendations, particularly during the preoperative phase. Improved implementation in these stages may reduce complications, ventilation duration, and overall length of stay.
Access Note
Access to this thesis is embargoed until 13th October 2027
Recommended Citation
Butler, D. (2026). Enhanced recovery after surgery: Improving the quality of postoperative care for the adult cardiac surgical patient in the intensive care unit. Edith Cowan University. Retrieved from https://ro.ecu.edu.au/theses/3130