Cardiac Surgery Fast-track Treatment in a Postanesthetic Care Unit

• DOI: 10.1097/aln.0b013e31817881b3
• Publication Date: 2009-03-05T18:10:34Z
• Authors: Joerg Ender; Michael Andrew Bo...; Markus Scholz; Anne-Kathrin Funkat; Nadeem Anwar; Marcus Sommer; Friedrich Wilhelm...; Jens Fassl
• Keywords: Male; Postoperative Care; Time Factors; Thoracic Surgery; Length of Stay; Middle Aged; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Anesthesia Recovery Period; Humans; Female; Aged; Recovery Room

Background The authors compared the safety and efficacy of a newly developed fast-track concept at their center, including implementation of a direct admission postanesthetic care unit, to standard perioperative management.

Methods All fast-track patients treated within the first 6 months of implementation of our direct admission postanesthetic care unit were matched via propensity scores and compared with a historical control group of patients who underwent cardiac surgery prior to fast-track implementation.

Results A total of 421 fast-track patients were matched successfully to 421 control patients. The two groups of patients had a similar age (64 +/- 13 vs. 64 +/- 12 yr for fast-track vs. control, P = 0.45) and European System for Cardiac Operative Risk Evaluation-predicted risk of mortality (4.8 +/- 6.1% vs. 4.6 +/- 5.1%, P = 0.97). Fast-track patients had significantly shorter times to extubation (75 min [45-110] vs. 900 min [600-1140]), as well as shorter lengths of stay in the postanesthetic or intensive care unit (4 h [3.0-5] vs. 20 h [16-25]), intermediate care unit (21 h [17-39] vs. 26 h [19-49]), and hospital (10 days [8-12] vs. 11 days [9-14]) (expressed as median and interquartile range, all P < 0.01). Fast-track patients also had a lower risk of postoperative low cardiac output syndrome (0.5% vs. 2.9%, P < 0.05) and mortality (0.5% vs. 3.3%, P < 0.01).

Conclusion The Leipzig fast-track protocol is a safe and effective method to manage cardiac surgery patients after a variety of operations.