Impact of early tracheal extubation on hospital discharge

Economic realities of the continuing increased utilization of cardiac surgery in the 1990s have led to the practice of early tracheal extubation and shortening of the length of intensive care unit and hospital stays. In this era of cost-containment and physician report cards, we are held accountable for patients' outcome in terms of mortality, morbidity, quality of life, length of stay, and cost of care. This report outlines the factors that influence costs of cardiac surgery. These include patient risk, anesthesia, surgical, intensive care unit, and health care systems or hospital factors. The current literature on outcome, utilization, and cost implications of early tracheal extubation in cardiac surgery is summarized and discussed. It has been demonstrated that early extubation anesthesia is safe and cost-effective and can improve resource utilization in cardiac surgery, but to achieve a maximum cost benefit from fast-track or early extubation anesthesia in cardiac patients, team organization of a fast-track cardiac surgery program must be implemented. A perioperative clinical pathway management in fast-track cardiac surgery is presented.