ADAPTING ENHANCED RECOVERY AFTER SURGERY (ERAS) PRINCIPLES FOR CARDIAC SURGERY IN A RESOURCE-LIMITED SETTINGS:A NURSE-LED APPROACH AT OAUTHC
Authors & Affiliations
Olutunde Mariam Titilayo Registered Cardiothoracic Nurse Deputy Director, Nursing Services, OAUTHC
📖 Abstract Content
Congenital heart disease affects approximately 12 per 1,000 live births in Nigeria, with Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) serving as a major referral centre. Post-operative recovery is often hindered by resource constraints, ICU limitations in terms of bed space, shortages of specialized staff, insecurity affecting follow-up care and sometimes prolonged ventilation and surgical site infection. While Enhanced Recovery After Surgery ( ERAS ) protocols have reduced complications by up to 50% globally. Standardized post operative pathways for paediatrics and adults cardiac patients should be adopted in all cardiac centres.
To propose a nurse-led adaptation of ERAS principles for cardiac surgery, feasible within a resource-limited Nigerian setting.
Approach: Outlining a bundle spanning the Perioperative continum: pre, intra and post- operative measures including Goal-directed fluids administration, normothermia, early respiratory and mobilization protocols including Nurse-led extubation readiness and chest physiotherapy: multimodal pain control, early enteral feeding, infection prevention, care giver education and structured discharge planning using Teach-back methods, multilingual pictorial leaflets, and tele-follow-up for families affected by insecurity.
Recommendations: Cardiac centres should adopt standardized ERAS protocols for paediatric and adult surgery; the Nursing and Midwifery Council of Nigeria should incorporate ERAS into Cardiothoracic Nursing curricula; and the Nigerian Cardiac Society should champion national policy for standardized implementation.
ERAS principles are feasible, low-cost, and high-impact even in resource-limited settings. Nurse-led implementation, supported by multidisciplinary collaboration among Surgeons, Anaesthesiologists, Cardiologists, and Cardiac Physiotherapists, offers a practical blueprint for improving cardiac surgical outcomes across Nigeria.
