Effect of Enhanced Recovery After Surgery (ERAS) Implementation on Postoperative Atrial Fibrillation in Cardiac Surgery

Background/Objectives: Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery and is associated with increased morbidity and prolonged recovery. This study aimed to evaluate the impact of an enhanced recovery after surgery (ERAS) program on the incidence of POAF and broader perioperative outcomes. Methods: In this monocentric, observational cohort study, we compared a retrospective pre-ERAS cohort (n = 162) with a prospective ERAS cohort (n = 321). The primary outcome was the incidence of POAF, assessed using two definitions: (1) the American Association for Thoracic Surgery (AATS) 2014 clinical definition, identifying POAF as atrial fibrillation requiring treatment; and (2) the European Society of Cardiology (ESC) 2024 definition, describing new-onset atrial fibrillation occurring immediately after surgery. Secondary outcomes included compliance with POAF prophylaxis measures, length of hospital stay, and the occurrence of postoperative complications. Statistical analyses included propensity score matching and multivariate logistic regression to identify independent predictors of POAF. Results: ERAS implementation was associated with a significant reduction in POAF incidence across both definitions. According to the AATS 2014 definition, POAF occurred in 20% of ERAS patients vs. 39% in the pre-ERAS group (p = 0.001), and 23% vs. 39% in the matched cohort (p = 0.004). Using the ESC 2024 definition, POAF was observed in 21% vs. 37% (p = 0.001) in unmatched and 20% vs. 36% (p = 0.005) in matched populations. Compliance with POAF prophylaxis improved markedly in the ERAS group (70% vs. 21%, p = 0.001). ERAS patients also experienced shorter hospital stays and fewer postoperative complications (26% vs. 38% in the matched cohort, p = 0.033). Conclusions: The implementation of a structured ERAS protocol significantly reduced POAF incidence, improved compliance with preventive strategies, and enhanced key aspects of postoperative recovery.