Comparison of immediate extubation versus ultrafast tracking strategy in the management of off-pump coronary artery bypass surgery

Nagre, Amarja Sachin; Jambures, Nagesh P

doi:10.4103/aca.aca_135_17

Cited by 14 publications

(1 citation statement)

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“…Montes et al [ 6 ] in a small study of 100 patients undergoing isolated coronary surgery found a non-significant increase in safety outcomes among patients extubated in the operating room. In contrast, Nagre and Jambures [ 17 ] did not detect a greater risk of safety events and did detect a reduction in ICU stay (5.7 vs 6.4 days) with a small increase of 19.8 min of operating room occupancy. In a study of >1000 patients, Dorsa et al found that patients undergoing coronary surgery without CPB, who were extubated in the operating room had a lower risk of reintubation (2.5% vs 16%, P < 0.001), kidney injury (2.2% vs 7.6%, P < 0.001) and mortality (1.2% vs 10.7%, P < 0.001) [ 18 ].…”

Section: Discussionmentioning

confidence: 87%

Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis

Carnero-Alcázar,

Beltrao-Sial,

Montero-Cruces

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES We aimed at comparing the risk of major adverse events and length of stay between patients undergoing ultrafast track and conventional fast track. METHODS Retrospective cohort study adjusted by propensity score matching, including patients operated on between March 2020 and December 2022 of any of the following: coronary, valve surgery or ascending aorta surgery. Patients were divided into 2 groups: ultrafast track: extubation in the operating room and fast track: extubation attempted in the first 6 postoperative hours. The primary objective was to compare the risk of the combined event death, lung respiratory outcomes (reintubation, mechanical ventilation longer than 24 h or pneumonia), or acute renal failure. RESULTS A total of 1126 patients were included. A total of 579 (51.4%) were extubated in the operating room. A total of 331 pairs were available after matching by propensity score. The risk of the primary outcome was 11.8% (n = 39) in the fast-track group and 6.3% (n = 21) in the ultrafast-track group (P = 0.013), mostly driven by lung adverse events (6.9% vs 2.4%, P = 0.011) while no significant differences were detected in the risk of death (2.4% vs 1.8%, P = 0.77) or acute renal failure (8% vs 6.3%, P = 0.56). The risk of myocardial infarction was higher in the fast-track group (2.7% vs 0%, P = 0.039). The median length of stay in the postoperative intensive care unit was longer in the fast-track group [24.7 h (interquartile range 21.5; 62.9) vs 23.5 h (interquartile range 22; 46), P = 0.015]. CONCLUSIONS In patients undergoing cardiac surgery, extubation in the operating room is associated to a lower risk of postoperative complications (mostly driven by lung adverse events) and length of stay in intensive care unit as compared to fast track.

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Section: Discussionmentioning

confidence: 87%