Fast-track recovery in noncoronary cardiac surgery patients.
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.
Toraman
Fevzi
F
Department of Anesthesiology, Acibadem Kadiköy Hospital, Istanbul, Turkey. ftoraman@tnn.net
Evrenkaya
Serdar
S
Yuce
Murat
M
Göksel
Onur
O
Karabulut
Hasan
H
Alhan
Cem
C
D006348:Cardiac Surgical Procedures; D015505:Chest Tubes; D002985:Clinical Protocols; D048909:Diabetes Complications; D004322:Drainage; D004632:Emergency Medical Services; D017707:Erythrocyte Transfusion; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000601:surgery*; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D016491:Peripheral Vascular Diseases / Q000150:complications; D011182:Postoperative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D020127:Recovery of Function; D013997:Time Factors; D015300:Ventilator Weaning