title: Predictors of Failure in Fast-Track Cardiac Surgery.
abstract: OBJECTIVE
  Fast-track (FT) management of cardiac surgery patients is associated with early extubation and reduced length of intensive care unit (ICU) stay, with potential benefit of reduced hospital costs. The authors examined perioperative factors and their influence on failure of FT and what implications this failure had.
  
  
  METHODS
  Prospective data collection from all adult cardiac surgeries between 2011 and 2013.
  
  
  METHODS
  Single-institution study.
  
  
  METHODS
  The study included 2,770 consecutive adult cardiac surgery patients.
  
  
  METHODS
  All participants underwent adult cardiac surgeries. Of those, 451 (16.3%) patients were selected to undergo FT management.
  
  
  RESULTS
  Failure of FT was defined as early (admission to ICU on day of surgery) or late (patients later admitted to the ICU from the ward). Univariate and multivariate regression analyses were used to identify which variables predicted FT failure. Of the 451 patients included in this study, 138 (30.6%) failed the FT, with 115 (83.3%) early failures and 23 (16.7%) late failures. Predictors of failure were reduced renal function, hypertension, age, EuroSCORE, cardiopulmonary bypass time, first lactate or base deficit after surgery (all p<0.01), and cross-clamp time (p<0.05). Multivariate analysis showed that the strongest predictor of failure was glomerular filtration rate (GFR)<65 mL/min/BSA (sensitivity, 54%; specificity, 61%; likelihood ratio, 1.39; area under receiver operating characteristics curve, 0.59; 95% confidence interval, 0.53-0.64). Median length of hospital stay was longer for the failed group (5 v 7 days, p<0.001). There were no mortalities in any of the patients selected for FT.
  
  
  CONCLUSIONS
  A number of perioperative factors are associated with failure to FT, the strongest predictor being GFR. Failure to FT can lead to significantly longer hospital stay.
authors.affiliation: Department of Cardiothoracic Surgery, St. George's Healthcare NHS Trust, London, United Kingdom. Electronic address: pyyoussefi@aol.com.
authors.forename: Pouya
authors.initials: P
authors.lastname: Youssefi
authors.affiliation: Department of Anaesthesia and Intensive Care, St. George's Healthcare NHS Trust, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Timbrell
authors.affiliation: Department of Cardiothoracic Surgery, St. George's Healthcare NHS Trust, London, United Kingdom.
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Valencia
authors.affiliation: Department of Anaesthesia and Intensive Care, St. George's Healthcare NHS Trust, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Gregory
authors.affiliation: Department of Anaesthesia and Intensive Care, St. George's Healthcare NHS Trust, London, United Kingdom.
authors.forename: Caterina
authors.initials: C
authors.lastname: Vlachou
authors.affiliation: Department of Cardiothoracic Surgery, St. George's Healthcare NHS Trust, London, United Kingdom.
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
authors.affiliation: Department of Anaesthesia and Intensive Care, St. George's Healthcare NHS Trust, London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Edsell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: cardiac surgery; fast-track; glomerular filtration rate; postoperative care