title: Do patients after off-pump coronary artery bypass grafting need the intensive care unit? A prospective audit of 85 patients.
abstract: With limited resources, cardiac surgery is frequently cancelled due to lack of ICU beds. Immediate postoperative extubation (UFT) is performed in our hospital setting. The aim of the present study is to report patients undergoing off-pump aortocoronary bypass grafting (OPCABG) with immediate extubation and no ICU stay. Eighty-five patients undergoing OPCABG were included. UFT analgesia consisted of high thoracic epidural analgesia (n=65), or PCA morphine (n=20). Discharge criteria from PACU to cardiac ward were: alert, cooperative patient, respiratory rate <25/min, PaO(2)>80 mmHg and PaCO(2)<45 mmHg, temperature >36 degrees C, hemodynamic stability, no bleeding, no ischemia, and sufficient analgesia. More males (71/14) were included. Mean age was 63.4 years, NYHA class III, ejection fraction 59.4. Three grafts were performed in 119 min. Patients were extubated 12+/-2 min after closure. After 428 min in PACU, four patients did not meet ward criteria; three bradycardia requiring pacing, one elevated CK-MB. Two patients returned to the ICU, one for hypertension, and one for hypovolemia. Cardiac complications were: atrial fibrillation (29%), MI=2, bradycardia=3. During the same period, 304 OR-extubated patients spent 21+/-6 h in the ICU. The cost from leaving the OR until the patient reached the cardiac ward was 1265$ for ICU bypass patients vs. 6405$ for ICU patients, the difference representing 5140$ per patient. ICU bypass after OPCABG is safe. By avoiding ICU, this protocol reduces costs, improves resource utilization and may reduce OR cancellation due to ICU bed shortages.
authors.affiliation: Department of Cardiac Surgery, Hôtel-Dieu du CHUM, Université de Montréal, Montréal, Québec, Canada. noiseuxn@videotron.ca
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.forename: David
authors.initials: D
authors.lastname: Bracco
authors.forename: Ignacio
authors.initials: I
authors.lastname: Prieto
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Hemmerling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000706:statistics & numerical data; D047549:Coronary Artery Bypass, Off-Pump / Q000191:economics / Q000706:statistics & numerical data*; D003325:Coronary Care Units / Q000191:economics / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000191:economics / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011792:Quebec