title: A clinical and economic evaluation of fast-track recovery after cardiac surgery.
abstract: BACKGROUND
  In the last 5 decades, the care of cardiac surgical patients has improved with the aid of strategies aimed at facilitating patient recovery. One of the innovations in this context is "fast-tracking" or "rapid recovery." This process refers to all interventions that aim to shorten a patient's stay in the intensive care unit (ICU) through accelerating the patient's transfer to a step-down or telemetry unit and to the general ward.
  
  
  METHODS
  Patients were allocated to 2 groups. The fast-track group (n = 84) went through an independent theatre recovery unit (TRU). The patients were then transferred on the same day to an intermediate care unit and transferred on the following day to the ward. The intensive care group (52 patients) went to the ICU for at least 1 day, after which they were transferred to the ward.
  
  
  CONCLUSIONS
  The fast-track pathway significantly reduced the length of stay (LOS) in an intensive care facility (P < .001). The duration of intubation was reduced from a median of 4.08 hours (range, 1.17-13.17 hours) in the intensive care group to 2.75 hours (range, 0.25-18.57 hours) in the fast-track group (P < .001). However, the median values for total hospital LOS, incidences of complications, reintubation, and readmission were similar for the 2 groups. The incidence of failure in the fast-track group was 10%. The mean (SD) cost of the perioperative care was £4182 ± £2284 ($6683 ± 3650) for the fast-track patients, compared with £4553 ± £1355 ($7277 ± $2165) for the intensive care group.
  
  
  CONCLUSIONS
  Fast-track recovery after cardiac surgery decreases the intensive care LOS and the total duration of intubation. It is a cost-effective strategy compared with conventional recovery protocols; however, it does not reduce the total hospital LOS or the incidence of complications.
authors.affiliation: Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom. kareemsal@doctors.org.uk
authors.forename: Kareem
authors.initials: K
authors.lastname: Salhiyyah
authors.forename: Sherif
authors.initials: S
authors.lastname: Elsobky
authors.forename: Shahzad
authors.initials: S
authors.lastname: Raja
authors.forename: Rizwan
authors.initials: R
authors.lastname: Attia
authors.forename: John
authors.initials: J
authors.lastname: Brazier
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D006348:Cardiac Surgical Procedures; D003422:Critical Care / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000191:economics* / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011446:Prospective Studies; D011997:Recovery Room / Q000191:economics*; D018709:Statistics, Nonparametric