Fast-Track Failure After Cardiac Surgery: Risk Factors and Outcome With Long-Term Follow-Up.

Area of Science:

• Anesthesiology
• Cardiac Surgery
• Critical Care Medicine

Background:

• Enhanced Recovery After Cardiac Surgery protocols emphasize fast-track anesthesia management.
• Fast-track failure can negatively impact immediate postoperative outcomes.
• Identifying risk factors for fast-track failure is crucial for improving patient care.

Purpose of the Study:

• To evaluate risk factors associated with fast-track anesthesia failure.
• To assess the short- and long-term effects of fast-track failure on patient outcomes.
• To determine predictors of fast-track failure in cardiac surgery patients.

Main Methods:

• Retrospective cohort study of 7,064 adult cardiac surgery patients (January 2013 - October 2019).
• Analysis focused on 1,097 patients meeting fast-track program criteria.
• Univariate and multivariate logistic regression identified independent risk factors for fast-track failure.

Main Results:

• Fast-track failure occurred in 6.3% of patients (69 individuals).
• Failure was linked to increased rates of re-operations, bleeding, atrial fibrillation, pneumonia, delirium, and sepsis.
• Higher postoperative length of stay and up to 5-year mortality were observed in the failure group.
• European System for Cardiac Operative Risk Evaluation II and blood transfusion were independent risk factors, with limited predictive ability (AUC = 0.676).

Conclusions:

• Fast-track failure is associated with significant increases in morbidity and long-term mortality.
• Predicting fast-track failure remains a clinical challenge.
• Further research is needed to improve the prediction and prevention of fast-track failure.