A coronary artery bypass "fast-track" protocol is practical and realistic in a rural environment.
BACKGROUND
In this study we determine retrospectively whether assignment of all patients undergoing coronary artery bypass grafting to a "fast-track" protocol (FT) is practical and realistic in our rural institution.


METHODS
We compared the outcome of 266 consecutive patients undergoing coronary artery bypass grafting who were fast-tracked in 1996 with that of 266 consecutive patients who were managed conventionally (NFT) in 1994. The surgical techniques were comparable in both groups; however, FT anesthesia used inhalational agents and short-acting narcotics. All comparisons were performed using the Student's t test or the chi 2 test.


RESULTS
Postoperatively 95% of the FT group were extubated by 24 hours compared with 0% in the NFT group (p < 0.0001). The mean intensive care unit length of stay in the FT group was 1.7 +/- 0.8 days, whereas it was 2.6 +/- 0.6 days in the NFT group (p < 0.001). The mean postoperative length of stay was 6.4 +/- 1.2 days in the FT group compared with 7.5 +/- 0.9 days in the NFT group (p < 0.001). There were no significant differences in 30-day morbidity/mortality. There was a substantial cost savings in the FT group.


CONCLUSIONS
The fast-track protocol can be successful without any compromise of patient care. Early discharge from the hospital, however, is not always feasible.
Quigley
R L
RL
Department of Surgery, Guthrie Clinic, Sayre, Pennsylvania 18840, USA.
Reitknecht
F L
FL
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000368:Aged; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000379:methods*; D017046:Cost Savings; D003422:Critical Care; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006760:Hospitalization; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D010107:Oxygenators, Membrane; D010351:Patient Discharge; D012189:Retrospective Studies; D012423:Rural Health; D012501:Saphenous Vein / Q000637:transplantation; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D009294:Narcotics