Does fast-track treatment lead to a decrease of intensive care unit and hospital length of stay in coronary artery bypass patients? A meta-regression of randomized clinical trials*

Mastrigt, Ghislaine A. P. G. van; Heijmans, John; Severens, Johan L.; Prins, Martin H.

doi:10.1097/01.ccm.0000217963.87227.7b

Cited by 72 publications

(42 citation statements)

References 55 publications

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“…Finally, a consistent reduction in postoperative pulmonary complications has not been shown when off-pump (as opposed to on-pump) CABG is performed (1209). 6 Rates of cardiovascular morbidity and mortality are increased in patients with CKD compared with age-matched controls without CKD, and the magnitude of the increase is directly related to the severity of CKD. About half of those on maintenance dialysis die from a cardiovascular cause (476).…”

Section: Anomalous Coronary Arteries: Recommendationsmentioning

confidence: 99%

See 1 more Smart Citation

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Hillis

Smith

Anderson³

et al. 2011

Journal of the American College of Cardiology

662

161

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Section: Anomalous Coronary Arteries: Recommendationsmentioning

confidence: 99%

“…Anesthetic management directed toward early postoperative extubation and accelerated recovery of low-to medium-risk patients undergoing uncomplicated CABG is recommended (4)(5)(6). (Level of Evidence: B) 2.…”

Section: Class Imentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Hillis

Smith

Anderson³

et al. 2011

Journal of the American College of Cardiology

662

161

View full text Add to dashboard Cite

“…[26][27][28][29] Van Mastrigt et al 30 published a large meta-analysis including 27 studies on fast tracking in adult cardiac surgery and found that fast tracking in general and early extubation in particular resulted in significant shorter ICU and hospital stay without an increase in morbidity and mortality. A similar meta-analysis in CHD patients concluded that early extubation, which is a main component of fast tracking, seems to be safe and was actually associated with lower early mortality.…”

Section: Discussionmentioning

confidence: 99%

Economic and Safety Implications of Introducing Fast Tracking in Congenital Heart Surgery

Lawrence

Nguyen

Morris

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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Background-The feasibility of fast-tracking children undergoing congenital heart disease surgery has not been assessed adequately. Current knowledge is based on limited single-center experiences without contemporaneous control groups. Methods and Results-We compared administrative data for atrial septal defect (ASD) and ventricular septal defect (VSD) surgeries in children 2 months to 19 years of age at the Mount Sinai Medical Center (MSMC) with data from comparable patients at 40 centers contributing to the Pediatric Health Information System. Three-year blocks, early in and after fast tracking had been implemented at the MSMC, were examined. Seventy-seven and 89 children at MSMC undergoing ASD and VSD closure, respectively, were compared with 3103 ASD and 4180 VSD patients nationally. With fast tracking fully implemented, median length of stay at the MSMC decreased by 1 day compared with the earlier era (length of stay, 1 and 3 days for ASD and VSD, respectively). Nationally, median length of stay remained unchanged (3 days for ASD and 4 days for VSD) in the observed time periods. Hospitalization costs fell by 33% and 35% at MSMC (ASD and VSD, respectively), whereas they rose by 16% to 17% nationally. When analyzed in multiple regression models, the decrease in both length of stay and cost remained significantly greater at MSMC compared with nationally (P<0.0001 for all). Hospital mortality and 2-week readmission rates were unchanged at MSMC between the 2 time periods and were not different from the national rates. Key Words: cardiac anesthesia ◼ mechanical ventilator ◼ pediatric cardiac surgery ◼ pediatric and congenital heart disease ◼ pediatric intensive care unit Conclusion-Shorter

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“…3 A 2011 American College of Cardiology guideline 11 gave a class 1 recommendation for an anesthetic directed toward early postoperative extubation among low-to medium-risk CABG patients. In a meta-analysis of fast-track cardiac practices, researchers 1 reported that although anesthetic management affects the ability to allow early extubation, an extubation protocol was pivotal, thus highlighting the importance of the work processes within a cardiac surgery unit.…”

mentioning

confidence: 99%

Quality Improvement Intervention to Decrease Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Hefner¹,

Tripathi²,

Abel³

et al. 2016

American Journal of Critical Care

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BackgroundIn 2010, the incidence of prolonged mechanical ventilation (> 24 hours) after isolated coronary artery bypass graft (CABG) surgery was 26.9% at the study site, The Ohio State University Wexner Medical Center, compared with the national like-hospital rate of 10.9%. Objectives To use the principles of lean management to reduce the incidence of prolonged mechanical ventilation and to assess the sustainability of that reduction over time. Methods A multidisciplinary prolonged ventilation task force conducted a gap analysis leading to 3 interventions: (1) a standardized extubation protocol, (2) dry erase boards in patients' rooms to facilitate team communication, and (3) edits of the postoperative order set within the electronic health record. Outcomes of mechanical ventilation in CABG patients before and after the interventions are compared. Results All target outcomes changed significantly after the interventions, including a reduction in the median hours of initial mechanical ventilation (from 11.4 hours to 6.9 hours, P < .001). The percentage of patients reintubated did not increase (a decrease from 11.8% to 3.5% was not significant, P = .08). The rate of prolonged ventilation decreased from 29.4% to 8.6% (P = .004), and this reduction was sustained for 4 years after the interventions. Conclusions Success factors included the multidisciplinary task force and continual protocol reeducation among front-line staff.

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Does fast-track treatment lead to a decrease of intensive care unit and hospital length of stay in coronary artery bypass patients? A meta-regression of randomized clinical trials*

Abstract: Although fast-track anesthetics and normothermic temperature management facilitate early extubation, the introduction of an early extubation protocol seems essential to decrease intensive care unit and hospital stay in low-risk coronary artery bypass grafting patients.

Cited by 72 publications

References 55 publications

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Economic and Safety Implications of Introducing Fast Tracking in Congenital Heart Surgery

Quality Improvement Intervention to Decrease Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

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