Advanced Practice Provider Approach to Early Enhanced Recovery After Aortic Surgery

J. L.. Feinberg¹, E. Breitinger², M. Querijero¹, M. Taylor¹, M. Peterson^2
1NYU Langone Health, New york, New York ²NYU Langone Health, NY, New York

Purpose: The feasibility and safety of an Advanced Practice Provider (APP)- driven post-operative progression protocol is unknown in patients undergoing aortic surgery. We intend to review outcomes of patients extubated in the operating room (OR) who underwent the APP-driven post-operative progression pathway vs. patients extubated in the intensive care unit (ICU).

Methods: The electronic medical record (EMR) and Society of Thoracic Surgeons (STS) data for patients who underwent aortic surgery with one aortic surgeon from August 2023 through March 2024 were analyzed. We compared perioperative and 30-day postoperative morbidity and mortality for patients who were extubated in the OR vs ICU. We also described the role of the APP in the post-operative progression pathway in the inpatient and outpatient post-operative setting.

Results: Of the 87 aortic surgery patients included in the preliminary data set, 89% were extubated in the OR and followed the post-operative progression protocol. Patients who were extubated in the OR and followed the progression protocol had a median out of bed in chair time of 3.7 hours and a median length of stay of 3.8 days, whereas patients who were extubated in the ICU had a median out of bed in chair time of 21.6 hours and a median length of stay of 5.8 days. There was no increase in post-operative morbidity or mortality in patients who underwent extubation in the OR.

Conclusion: Routine extubation in the OR is feasible and safe for patients undergoing aortic surgery. Patients who underwent extubation in the OR and the post-operative progression pathway had shorter out of bed time and shorter length of stay than patients who were extubated in the ICU. The APP, in collaboration with the interdisciplinary team, plays a key role in advancing patients along the post-operative progression pathway.

Identify the source of the funding for this research project: N/a