Document Detail


Fast-track recovery in noncoronary cardiac surgery patients.
MedLine Citation:
PMID:  15769719     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Fast-track recovery protocols result in shorter hospital stays and decreased costs in coronary artery bypass grafting (CABG) surgery. However, data based on an objective scoring system are lacking for the impact of these protocols on patients undergoing cardiac surgery other than isolated CABG. METHODS: Between March 1999 and March 2003, 299 consecutive patients who underwent open cardiac surgery other than isolated CABG were analyzed to evaluate the safety and efficacy of fast-track recovery. The parameters evaluated as predictors of mortality, ie, delayed extubation (>360 minutes), intensive care unit (ICU) discharge (>24 hours), increased length of hospital stay (>5 days), and red blood cell transfusion, were determined by regression analysis. Standard perioperative data were collected prospectively for every patient. RESULTS: Seventy-two percent of the patients were extubated within 6 hours, 87% were discharged from the ICU within 24 hours, and 60% were discharged from the hospital within 5 days. No red blood cells were transfused in 67% of the patients. There were no predictors of mortality. The predictors of delayed extubation were preoperative congestive heart failure (P = .005; odds ratio [OR], 4.5; 95% confidence interval [CI], 1.6-12.6) and peripheral vascular disease (P = .02; OR, 6; 95% CI, 1.9-19.4). Factors leading to increased ICU stay were diabetes (P = .05; OR, 3.6; 95% CI, 1-12.6), emergent operation (P = .04; OR, 6.1; 95% CI, 1.1-33.2), red blood cell transfusion (P = .03; OR, 2.9; 95% CI, 1.1-7.8), chest tube drainage >1000 mL (P = .03; OR, 3.4; 95% CI, 1.1-10.2). The predictors of increased length of hospital stay were ICU stay >24 hours (P = .001; OR, 5.9; 95% CI, 2-17), EuroSCORE >5 (P = .05; OR, 1.8; 95% CI, 1-3.2), and chronic obstructive pulmonary disease (P = .003; OR, 3.7; 95% CI, 1.5-8.7). Predictive factors for transfusion of red blood cells were diabetes (P = .04; OR, 2.9; 95% CI, 1.1-8.1), delayed extubation (P = .02; OR, 2.7; 95% CI, 1.4-5.1), increased ICU stay (P = .04; OR, 2.6; 95% CI, 1-6.4), and chest tube drainage >1000 mL (P = .001; OR, 4.3; 95% CI, 2-9.3). CONCLUSIONS: This study confirms the safety and efficacy of the fast-track recovery protocol in patients undergoing open cardiac surgery other than isolated CABG.
Authors:
Fevzi Toraman; Serdar Evrenkaya; Murat Yuce; Onur Göksel; Hasan Karabulut; Cem Alhan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The heart surgery forum     Volume:  8     ISSN:  1522-6662     ISO Abbreviation:  Heart Surg Forum     Publication Date:  2005  
Date Detail:
Created Date:  2005-03-16     Completed Date:  2006-12-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100891112     Medline TA:  Heart Surg Forum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E61-4     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Acibadem Kadiköy Hospital, Istanbul, Turkey. ftoraman@tnn.net
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures*
Chest Tubes
Clinical Protocols*
Diabetes Complications
Drainage
Emergency Medical Services
Erythrocyte Transfusion
Female
Heart Diseases / complications,  surgery*
Heart Failure / complications
Humans
Intensive Care Units
Length of Stay
Male
Patient Discharge
Peripheral Vascular Diseases / complications
Postoperative Care*
Pulmonary Disease, Chronic Obstructive / complications
Recovery of Function
Time Factors
Ventilator Weaning

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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