Fast-track practice in cardiac surgery: Results and predictors of outcome

Haanschoten, Marco C., van Straten, Albert H. M., ter Woorst, Joost F., Stepaniak, Pieter S., van der Meer, Auke-Dick, van Zundert, Andre A. J. and Hamad, Mohamed A. Soliman (2012) Fast-track practice in cardiac surgery: Results and predictors of outcome. Interactive Cardiovascular and Thoracic Surgery, 15 6: 989-994. doi:10.1093/icvts/ivs393


Author Haanschoten, Marco C.
van Straten, Albert H. M.
ter Woorst, Joost F.
Stepaniak, Pieter S.
van der Meer, Auke-Dick
van Zundert, Andre A. J.
Hamad, Mohamed A. Soliman
Title Fast-track practice in cardiac surgery: Results and predictors of outcome
Journal name Interactive Cardiovascular and Thoracic Surgery   Check publisher's open access policy
ISSN 1569-9293
1569-9285
Publication date 2012
Year available 2012
Sub-type Article (original research)
DOI 10.1093/icvts/ivs393
Open Access Status DOI
Volume 15
Issue 6
Start page 989
End page 994
Total pages 6
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Abstract Objectives: 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. Method: 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]. Conclusion: 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.
Keyword Anaesthesia
Cardiac surgery
Fast-track
Outcome
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Thu, 07 May 2015, 12:25:44 EST by Andre Van Zundert on behalf of Anaesthesiology and Critical Care - RBWH