Fast tracking in cardiac surgery: is it safe?

Authors

Jeffrey B. MacLeod, Cardiovascular Research New Brunswick, Saint John Regional Hospital, Saint John, NB, Canada.
Kenneth D'Souza, Cardiovascular Research New Brunswick, Saint John Regional Hospital, Saint John, NB, Canada.
Christie Aguiar, Cardiovascular Research New Brunswick, Saint John Regional Hospital, Saint John, NB, Canada.
Craig D. Brown, Cardiovascular Research New Brunswick, and Department of Cardiac Surgery, Saint John Regional Hospital, Saint John, NB, Canada.
Zlatko Pozeg, Cardiovascular Research New Brunswick, and Department of Cardiac Surgery, Saint John Regional Hospital, Saint John, NB, Canada.
Christopher White, Cardiovascular Research New Brunswick, and Department of Cardiac Surgery, Saint John Regional Hospital, Saint John, NB, Canada.
Rakesh C. Arora, Max Rady College of Medicine, Department of Surgery, University of Manitoba, St. Boniface Hospital, Winnipeg, MB, Canada.
Jean-François Légaré, Cardiovascular Research New Brunswick, and Department of Cardiac Surgery, Saint John Regional Hospital, Saint John, NB, Canada.
Ansar Hassan, Department of Cardiovascular Surgery, Maine Medical Center, Portland, Maine, USA. ansar.hassan@mainehealth.org.

Document Type

Article

Publication Date

4-6-2022

Journal Title

Journal of cardiothoracic surgery

MeSH Headings

Airway Extubation; Cardiac Surgical Procedures (adverse effects); Coronary Artery Bypass; Humans; Length of Stay; Postoperative Complications (epidemiology, etiology); Retrospective Studies

Abstract

BACKGROUND: While fast track clinical pathways have been demonstrated to reduce resource utilization in patients undergoing cardiac surgery, it remains unclear as to whether they adversely affect post-operative outcomes. The purpose of this study was to determine the impact of fast tracking on post-operative outcomes following cardiac surgery. METHODS: In a retrospective study, all patients undergoing first-time, on-pump, non-emergent coronary artery bypass grafting, valve, or coronary artery bypass grafting + valve at a single centre between 2010 and 2017 were included. Patients were considered to have been fast tracked if they were extubated and transferred from intensive care to a step-down unit on the same day as their procedure. The risk-adjusted effect of fast tracking on a 30-day composite of all-cause mortality, stroke, renal failure, infection, atrial fibrillation, and readmission to hospital was determined. Furthermore, propensity score matching was used to match fasting track patients in a 1-to-1 manner with their nearest "neighbor" in the control group and subsequently compared in terms of 30-day post-operative outcomes. RESULTS: 3252 patients formed the final study population (fast track: n = 245; control: n = 3007). Patients who were fast tracked experienced reduced time to initial extubation (4.3 vs. 5.6 h, p < 0.0001) and lower median initial intensive care unit length of stay (7.8 vs. 20.4 h, p < 0.0001). Fast tracked patients experienced lower 30-day rates of the composite outcome (42.4% vs. 51.5%, p = 0.008). However, following propensity score matching, fast tracked patients experienced similar 30-day rates of the composite outcome as the control group (42.4% vs. 44.5%, p = 0.72). After risk adjustment using multivariable regression modeling, fast tracking was predictive of an improved 30-day composite outcome (OR 0.75, 95% CI 0.57-0.98, p = 0.03). CONCLUSION: Fast track clinical pathways was associated with reduced intensive care unit, overall length of stay and similar 30-day post-operative outcomes. These results suggest that fast tracking appropriate patients may reduce resource utilization, while maintaining patient safety.

First Page

69

Recommended Citation

MacLeod JB, D'Souza K, Aguiar C, Brown CD, Pozeg Z, White C, Arora RC, Légaré JF, Hassan A. Fast tracking in cardiac surgery: is it safe? J Cardiothorac Surg. 2022 Apr 6;17(1):69. doi: 10.1186/s13019-022-01815-9. PMID: 35382846; PMCID: PMC8983083.