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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Risk factor analysis for fast track protocol failure.
Arndt H Kiessling1, Patrick Huneke, Christian Reyher
1Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany. cardiac.surgeon@dr-kiessling.com
Journal of Cardiothoracic Surgery
|March 19, 2013
Summary
Fast-track cardiac surgery protocols aim to reduce intensive care unit (ICU) stays. However, failure to transfer or readmission to the ICU indicates poor patient outcomes, with specific predictors identified.
Area of Science:
- Cardiac Surgery
- Intensive Care Medicine
- Patient Management Protocols
Background:
- Fast-track protocols in cardiac surgery aim to shorten intensive care unit (ICU) hospitalization.
- Readmission to the ICU is a critical indicator of negative patient outcomes and protocol effectiveness.
Purpose of the Study:
- To statistically analyze risk factors and predictors for ICU readmission following fast-track cardiac surgery.
- To identify independent predictors for the failure of fast-track patient management programs.
Main Methods:
- Retrospective analysis of 229 cardiac surgery patients undergoing a preoperative fast-track protocol.
- Uni- and multivariate analyses were employed to identify predictors for ICU readmission.
- Data collected included patient demographics, operation details, and postoperative outcomes.
Main Results:
- 36% of patients failed to transfer to an intermediate care unit (IMC) on the day of surgery, and 4% required ICU readmission.
- Failure of the fast-track procedure was predicted by a preoperative American Society of Anesthesiologists (ASA) class >3, New York Heart Association (NYHA) class >III, and operation time >267 minutes.
- Significant risk factors for major postoperative events included a poor ejection fraction (EF) and ICU readmission.
Conclusions:
- Failure to transfer to IMC or ICU readmission is associated with significantly worse patient outcomes.
- Preoperative ASA class >3, NYHA class >III, and prolonged operation times (>267 minutes) are independent predictors of fast-track protocol failure.
- Identifying these predictors is crucial for optimizing patient selection and management within fast-track programs.
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