Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept
Anesthesiology, 109 (1):
61–66 (2008)Abstract
BACKGROUND\r\nThe 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.\r\nMETHODS\r\nAll 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.\r\nRESULTS\r\nA 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).\r\nCONCLUSION\r\nThe Leipzig fast-track protocol is a safe and effective method to manage cardiac surgery patients after a variety of operations.