title: Fast-track practice in cardiac surgery: results and predictors of outcome.
abstract: OBJECTIVE
  Various studies have shown different parameters as independent risk factors in predicting the success of fast-track postoperative management in cardiac surgery. In the present study, we evaluated our 7-year experience with the fast-track protocol and investigated the preoperative predictors of successful outcome.
  
  
  METHODS
  Between 2004 and 2010, 5367 consecutive patients undergoing cardiac surgery were preoperatively selected for postoperative admission in the postanaesthesia care unit (PACU) and were included in this study. These patients were then transferred to the ordinary ward on the same day of the operation. The primary end-point of the study was the success of the PACU protocol, defined as discharge to the ward on the same day, no further admission to the intensive care unit and no operative mortality. Logistic regression analysis was performed to detect the independent risk factors for failure of the PACU pathway.
  
  
  RESULTS
  Of 11,895 patients undergoing cardiac surgery, 5367 (45.2%) were postoperatively admitted to the PACU. The protocol was successful in 4510 patients (84.0%). Using the multivariate logistic regression analysis, older age and left ventricular dysfunction were found to be independent risk factors for failure of the PACU protocol [odds ratio of 0.98/year (0.97-0.98) and 0.31 (0.14-0.70), respectively].
  
  
  CONCLUSIONS
  Our fast-track management, called the PACU protocol, is efficient and safe for the postoperative management of selected patients undergoing cardiac surgery. Age and left ventricular dysfunction are significant preoperative predictors of failure of this protocol.
authors.affiliation: Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Marco C
authors.initials: MC
authors.lastname: Haanschoten
authors.forename: Albert H M
authors.initials: AH
authors.lastname: van Straten
authors.forename: Joost F
authors.initials: JF
authors.lastname: ter Woorst
authors.forename: Pieter S
authors.initials: PS
authors.lastname: Stepaniak
authors.forename: Auke-Dick
authors.initials: AD
authors.lastname: van der Meer
authors.forename: André A J
authors.initials: AA
authors.lastname: van Zundert
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Soliman Hamad
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002985:Clinical Protocols; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D010360:Patient Transfer; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D015397:Program Evaluation; D011997:Recovery Room; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications; D055815:Young Adult