Impact of the post-anesthetic care unit opening hours on fast-track success in cardiac surgery.
BACKGROUND
Fast-track (FT) treatment in cardiac anesthesia is a state-of-the-art technique. The aim of our study was to compare FT treatment in a post-anesthetic care unit (PACU) with limited opening hours with a PACU opened for unlimited hours. Primary endpoints were extubation time (ET), length of stay (LOS) in PACU and LOS in intermediate care unit (IMC). Secondary endpoints were FT success/failure, hospital LOS, re-intubation and in hospital mortality.


METHODS
At our institution, FT is usually managed in a PACU with limited opening hours from 10 a.m. to 10 p.m., Monday to Friday (PACU12). Due to reconstruction work in 2011, this PACU was open 24 hours a day, Monday to Saturday (PACU24). We retrospectively compared patients admitted to PACU24 during 2011 (January to December) and patients admitted to PACU12 during 2013 (January to December).


RESULTS
A total of 2174 patients were primarily included in the study, 319 of them had to be excluded. Primary endpoints in PACU12 compared to PACU24 were significantly shorter: median ET (2.0 [95% confidence interval: 1.4-2.8] vs. 3.3 [95% CI: 2.2-5.0] hours), median LOS in PACU (4.8 [95% CI: 4.0-5.9] vs. 21.2 [95% CI: 18.3-23.5] hours) and median LOS in IMC (24 [95% CI: 18-64] vs. 38 [95% CI: 22-77] hours). FT success was significantly higher in PACU12 compared to PACU24 (75.3% vs. 39.6%). The in-hospital mortality and re-intubation rate were not significantly different.


CONCLUSIONS
FT treatment in a PACU with limited opening hours leads to more effective treatment for patients regarding extubation time and LOS in IMC than in a PACU with limited opening hours, without compromising safety.
Department of Anesthesiology and Intensive Care Medicine, Leipzig Heart Centre, Leipzig, Germany.
Christian
C
GRAß
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Federica
F
Stretti
Department of Anesthesiology and Intensive Care Medicine, Leipzig Heart Centre, Leipzig, Germany.
Waseem
W
Zakhary
Department of Anesthesiology and Intensive Care Medicine, Leipzig Heart Centre, Leipzig, Germany.
Edwin
E
Turton
Department of Anesthesiology and Intensive Care Medicine, Leipzig Heart Centre, Leipzig, Germany.
Sophia
S
Sgouoropoulou
Department of Coordinating Centre for Clinical Trials, University of Leipzig, Leipzig, Germany.
Meinhard
M
Mende
Department of Anesthesiology and Intensive Care Medicine, Leipzig Heart Centre, Leipzig, Germany - joerg.ender@helios-kliniken.de.
Jörg
J
Ender
D039602:After-Hours Care / Q000458:organization & administration; D000368:Aged; D060666:Airway Extubation; D000762:Anesthesia Recovery Period; D006348:Cardiac Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies; D013997:Time Factors