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Fast-track recovery in noncoronary cardiac surgery patients
Fevzi Toraman1, Serdar Evrenkaya, Murat Yuce
1Department of Anesthesiology, Acibadem Kadiköy Hospital, Istanbul, Turkey. ftoraman@tnn.net
Insights
Fast-track recovery protocols are safe and effective for patients undergoing open cardiac surgery beyond coronary artery bypass grafting. This approach leads to shorter hospital stays and reduced costs, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Fast-track recovery protocols are established for coronary artery bypass grafting (CABG), reducing hospital stays and costs.
- Objective data on fast-track protocols for non-CABG cardiac surgery patients are limited.
- Evaluating fast-track efficacy in diverse open cardiac surgery populations is crucial.
Purpose of the Study:
- To assess the safety and efficacy of fast-track recovery protocols in patients undergoing open cardiac surgery other than isolated CABG.
- To identify predictors of delayed extubation, intensive care unit (ICU) discharge, prolonged hospital stay, and red blood cell transfusion in this patient group.
Main Methods:
- Analysis of 299 consecutive patients undergoing open cardiac surgery (excluding isolated CABG) between March 1999 and March 2003.
- Prospective collection of standard perioperative data.
- Regression analysis to identify predictors of mortality, delayed extubation, ICU discharge, hospital stay, and transfusion.
Main Results:
- 72% extubated within 6 hours, 87% discharged from ICU within 24 hours, 60% discharged from hospital within 5 days.
- 67% of patients did not require red blood cell transfusion.
- Preoperative congestive heart failure and peripheral vascular disease predicted delayed extubation. Diabetes, emergent operation, transfusion, and chest tube drainage predicted increased ICU stay.
Conclusions:
- The fast-track recovery protocol is safe and effective for patients undergoing open cardiac surgery beyond isolated CABG.
- Understanding predictors of adverse events can further optimize fast-track implementation.
- This protocol contributes to improved resource utilization and patient recovery.
Objective:
Fast-track recovery protocols result in shorter hospital stays and decreased costs in coronary artery bypass grafting (CABG) surgery. However, data based on an objective scoring system are lacking for the impact of these protocols on patients undergoing cardiac surgery other than isolated CABG.
Methods:
Between March 1999 and March 2003, 299 consecutive patients who underwent open cardiac surgery other than isolated CABG were analyzed to evaluate the safety and efficacy of fast-track recovery. The parameters evaluated as predictors of mortality, ie, delayed extubation (>360 minutes), intensive care unit (ICU) discharge (>24 hours), increased length of hospital stay (>5 days), and red blood cell transfusion, were determined by regression analysis. Standard perioperative data were collected prospectively for every patient.
Results:
Seventy-two percent of the patients were extubated within 6 hours, 87% were discharged from the ICU within 24 hours, and 60% were discharged from the hospital within 5 days. No red blood cells were transfused in 67% of the patients. There were no predictors of mortality. The predictors of delayed extubation were preoperative congestive heart failure (P = .005; odds ratio [OR], 4.5; 95% confidence interval [CI], 1.6-12.6) and peripheral vascular disease (P = .02; OR, 6; 95% CI, 1.9-19.4). Factors leading to increased ICU stay were diabetes (P = .05; OR, 3.6; 95% CI, 1-12.6), emergent operation (P = .04; OR, 6.1; 95% CI, 1.1-33.2), red blood cell transfusion (P = .03; OR, 2.9; 95% CI, 1.1-7.8), chest tube drainage >1000 mL (P = .03; OR, 3.4; 95% CI, 1.1-10.2). The predictors of increased length of hospital stay were ICU stay >24 hours (P = .001; OR, 5.9; 95% CI, 2-17), EuroSCORE >5 (P = .05; OR, 1.8; 95% CI, 1-3.2), and chronic obstructive pulmonary disease (P = .003; OR, 3.7; 95% CI, 1.5-8.7). Predictive factors for transfusion of red blood cells were diabetes (P = .04; OR, 2.9; 95% CI, 1.1-8.1), delayed extubation (P = .02; OR, 2.7; 95% CI, 1.4-5.1), increased ICU stay (P = .04; OR, 2.6; 95% CI, 1-6.4), and chest tube drainage >1000 mL (P = .001; OR, 4.3; 95% CI, 2-9.3).
Conclusions:
This study confirms the safety and efficacy of the fast-track recovery protocol in patients undergoing open cardiac surgery other than isolated CABG.
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