# Enhanced recovery mitigates sodium-glucose cotransporter-2 inhibitors associated mobility decline in valve surgery patients

## TL;DR

SGLT2 inhibitors used in heart disease patients can cause mobility issues after surgery, but enhanced recovery protocols help reduce these effects.

## Contribution

This study shows that ERAS protocols can mitigate SGLT2i-associated mobility decline in valve surgery patients.

## Key findings

- QT group had longer ICU stays and delayed mobilization compared to TT group.
- QT group showed lower ADL scores and higher stress ulcer risk post-anesthesia.
- ERAS protocols improved functional recovery by discharge in QT patients.

## Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are integral to quadruple therapy for perioperative heart failure management in valvular heart disease (VHD) patients. Despite cardioprotective benefits, SGLT2i use correlates with acute sarcopenia and mobility impairment. This study evaluated whether Enhanced Recovery After Surgery (ERAS) protocols mitigate SGLT2i-associated mobility limitations.

In a single-center, retrospective cohort study [conducted from (Start Date) to (End Date)], 48 VHD patients undergoing valve surgery under an Enhanced Recovery After Surgery (ERAS) protocol were analyzed (Quadruple therapy [QT] with SGLT2i, n = 34; Triple therapy [TT] without SGLT2i, n = 14). Primary outcomes assessed mobility via Activities of Daily Living (ADL, Barthel Index), stress ulcer risk (Braden scale), and fall risk (Modified Thomas scale) at multiple perioperative timepoints. Secondary outcomes included ERAS metrics (ICU duration, mobilization times), cardiac function, and laboratory parameters.

The QT group experienced significantly longer ICU stays than the TT group (median 49 vs. 43 h, p = 0.003), indicating greater initial morbidity and resource utilization. The time to first off-bed mobilization was also delayed in the QT group (67 vs. 53 h, p = 0.042), a 14-hour delay that heightens the risk of muscle atrophy and pulmonary complications. Post-anesthesia recovery: QT showed lower ADL scores (10 vs. 15, p = 0.007) and higher stress ulcer risk (Braden 13 vs. 16, p = 0.025). ICU discharge: QT maintained higher stress ulcer risk (Braden 16 vs. 17, p = 0.006). Secondary care: QT demonstrated superior ADL recovery (95 vs. 85, p = 0.017) and lower stress ulcer risk (Braden 22 vs. 21, p = 0.043). No intergroup differences in cardiac function or laboratory parameters (p > 0.05). Multivariate analysis identified ICU duration, mechanical ventilation time, platelets, albumin, and NT-proBNP as significant mobility correlates (|r| = 0.368–0.625, p < 0.05).

SGLT2i use is associated with transient perioperative mobility impairment in VHD patients, evidenced by longer ICU stays and delayed mobilization. However, a structured ERAS protocol effectively mitigates these limitations, facilitating superior functional recovery by discharge. These findings underscore the necessity of adapting or closely monitoring ERAS protocols, particularly for patients on SGLT2i, to mitigate early mobility deficits. This supports tailoring ERAS pathways, particularly early mobilization, for this patient population.