title: Readmission and mortality in patients undergoing off-pump coronary artery bypass surgery with fast-track recovery protocol.
abstract: The development of less invasive methods for myocardial revascularization such as "off-pump" cardiac surgery, and new methods of anesthesia and postoperative care protocols such as "fast-track recovery" (FTRC), have contributed to a significant reduction in postoperative intensive care unit (ICU) and hospital length of stay after cardiac surgical procedures. The objectives of this study were to identify perioperative risk factors of prolonged hospital stay, hospital mortality, and readmission rates in off-pump coronary artery bypass surgery (CABG) patients undergoing the FTRC protocol. Eighty consecutive patients undergoing off-pump coronary artery bypass surgery with FTRC protocol were included in the study. For the first purpose of this protocol, early extubation is defined as removal of the endotracheal tube within 6 h of arrival at the surgical ICU. The second purpose was to obtain a minimal length of stay in the ICU (<24 h) and hospital discharge within 5 days. We analyzed the influence of the preoperative, intraoperative, and postoperative variables on prolonged hospital stay, hospital mortality, and hospital readmission. Three patients died during hospitalization, giving a hospital mortality rate of 3.75%. The causes of hospital death were massive stroke and sepsis. Using multivariate logistic regression analysis, hypertension (P = 0.0185), postoperative stroke (P = 0.0001), and sternal infection (P = 0.0007) were identified as independent predictors of hospital mortality. Mean hospital length of stay was 4.23 +/- 0.75 days. Univariate and multivariate logistic regression analysis revealed that postoperative blood use (P = 0.0095) was the major independent predictor of prolonged hospital stay. During the 30-day observation period, seven patients were readmitted. One of these patients died on postoperative day 45 from mediastinitis and sepsis. Multivariate logistic regression analysis identified age (P = 0.0033) and hypertension (P = 0.045) as independent predictors of hospital readmission. FTRC protocols can be performed safely in patients with off-pump CABG, and the mortality and readmission rates following this protocol were found to be within acceptable ranges.
authors.affiliation: Department of Cardiovascular Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey. celkan@superonline.com
authors.forename: M Adnan
authors.initials: MA
authors.lastname: Celkan
authors.forename: Hasim
authors.initials: H
authors.lastname: Ustunsoy
authors.forename: Bahadir
authors.initials: B
authors.lastname: Daglar
authors.forename: Hakki
authors.initials: H
authors.lastname: Kazaz
authors.forename: Hasan
authors.initials: H
authors.lastname: Kocoglu
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000401:mortality*; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000401:mortality*; D003325:Coronary Care Units / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000191:economics; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012306:Risk