Risk factor analysis for fast track protocol failure

Kiessling, Arndt-Holger; Huneke, P; Reyher, Christian; Bingold, Tobias M.; Zierer, Andreas; Moritz, Anton

doi:10.1186/1749-8090-8-47

Cited by 36 publications

(23 citation statements)

References 31 publications

(47 reference statements)

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“…Another factor of objection may be the length of ICU stays in the overall group and Group N. There was about 4 days of ICU stay for the overall group, which can be determined to be too long. Fast track surgery is used increasingly, and successful outcome results have been reported (1,16). Our analysis marks the point that even with a long ICU stay, there is a considerable rate of ICU readmission, especially in the high-risk groups.…”

Section: Discussionmentioning

confidence: 79%

Spinal Anaesthesia and Perioperative Anxiety

Mingir¹,

Ervatan²,

Turgut³

2014

Turk J Anesth Reanim

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Original Article / Özgün Araştırma 162 Amaç: Koroner baypas (KABG) ameliyatları sonrasında yeniden yoğun bakım ünitesine (YBÜ) yatış belli bir oranda görülür ve seyri kötüdür. Bu çalışmada tek merkezde KABG uygulanmış hastalarda yeniden YBÜ'ne yatış risk faktörleri analiz edilmiştir.Yöntemler: Tek bir merkezde koroner baypas ameliyatına alı-nan 679 hastanın prospektif olarak toplanan verileri, yeniden YBÜ'ne yatış risk faktörlerinin değerlendirilmesi için retrospektif olarak lojistik regresyon analizi ile incelendi. Yeniden YBÜ'ne yatış ihtiyacı olan hastalar (Grup R) ile diğerleri (Grup N) karşılaştırıldı. Bulgular:Otuz altı hasta (%5,3) yeniden YBÜ'ne yatırıldı. Postoperatif hastane mortalitesi, pulmoner ve nörolojik morbidite sırasıyla 43 (%6,3), 135 (%19,9 ve 46 (%6,8) hastada görüldü. Grupların karşılaştırmasında mortalite ve morbiditenin Grup R'de Grup N'ye göre anlamlı olarak daha yüksek olduğu görüldü (mortalite %16,7'ye karşı %5,9, p=0,029; pulmoner morbidite %66,7'ye karşı %17,3, p=0,0001; nörolojik morbidite %38,9'a karşı %5,0, p=0,0001). Yeniden YBÜ'ne yatış ile anlamlı ilişki-si olan faktörler ameliyat öncesi sol ventrikül işlev bozukluğu olması (Odds oranı (OR)=4,1; %95 güvenlik aralığı (CI)=1,4-12,5; p=0,013), ileri NYHA sınıfı (OR=5,3; %95 CI=1,3-21,7; p=0,022), pulmoner komplikasyonlar (OR=7,3; %95 CI=2,1-25,5; p=0,002) ve nörolojik komplikasyonlar (OR=4,6; %95 CI=1,3-16,7; p=0,021) idi.Sonuç: KABG sonrası yeniden YBÜ'ne yatırılan hastalarda daha yüksek oranda mortalite, pulmoner ve nörolojik komplikasyonlar görülmektedir. Sol ventrikül işlev bozukluğu, ileri NYHA sınıfı ve postoperatif pulmoner ve nörolojik komplikasyon görülmesi yeniden YBÜ'ne yatış için anlamlı risk faktörleridir.Anahtar Kelimeler: Koroner arter baypas, yoğun bakım ünitesi, yeniden yatış, risk faktörü Objective: Intensive care unit (ICU) readmissions after coronary bypass (CABG) operations occur in a significant number of patients, and the prognosis is poor. We analyzed the risk factors for ICU readmissions after CABG operations in a single institution. Methods:We retrospectively analyzed the prospectively collected data of 679 coronary bypass patients operated in a single institution in order to evaluate the risk factors for readmittance to the ICU with logistic regression analysis. The outcome results of patients readmitted to the ICU (Group R) and others (Group N) were compared.Results: Thirty-six (5.3%) patients were readmitted to the ICU. Postoperative in-hospital mortality and pulmonary and neurologic morbidity occurred in 43 (6.3%), 135 (19.9%), and 46 (6.8%) patients, respectively. The comparison of groups showed that mortality and morbidity were significantly higher in Group R compared to Group N (mortality 16.7% vs. 5.9, p=0.029; pulmonary morbidity 66.7% vs. 17.3%, p=0.0001; neurologic morbidity 38.9% vs. 5.0%, p=0.0001). Features associated with readmission included presence of left ventricular dysfunction preoperatively[odds ratio (OR)=4.1; 95% confidence interval (CI)=1.4-12.5; p=0.013], advanced NYHA Class (OR=...

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Section: Discussionmentioning

confidence: 79%

Spinal Anaesthesia and Perioperative Anxiety

Mingir¹,

Ervatan²,

Turgut³

2014

Turk J Anesth Reanim

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“…We know in patients undergoing cardiac surgery that ASA>3, NYHA>3 and operation time>267 min are independent predictors of fast-track protocol failure [1]. Especially advanced age and left ventricular dysfunction (EF<35%) found to be significant preoperative predictors of failure.…”

Section: Discussionmentioning

confidence: 99%

The Use of a Fast-Track Protocol for Perioperative Management of Cardiac Surgery Patients

2017

JACCOA

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Background: Cardiac Surgery dept. is a new unit of Joint Corps Armed Forces since March 2013. In order to support the project of organization and opening of a direct admission CS-ICU supported by minimum but well trained staff nurses we developed a fast-track concept. Methods:After an 8 months observation period, cooperation with the other parts of the dept. and the local medical ethics committee approval, we put in application the use of Leipzig fast-track protocol. It is about well-prepared but not selected patients. It regards their perioperative period until they discharge hospital. The database contains these 3 perioperative periods as multifactorial indicators.Results: Readmission is associated with patient outcomes. ASA, NYHA, perfusion XCL time and temperature at admission are predictors [1] of early extubation, short duration of ICU care, hospitalization and readmission. It also proves a high quality level of CS-ICU organization, based on the use of protocols as ORCHESTRA study [2] suggest, ready to respond challenges. Conclusion:In well preoperative prepared patients, we found that the Leipzig fasttrack protocol [3] is safe for cardiac surgery patients and an efficient method to combat the problem of decreasing numbers of ICU beds, working nurses and to save costs as a result of shortened length of stay [4].

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“…These studies mainly have shown the benefits of fast track protocol in cardiac surgery. However, Kiessling et al reported that risk factors that could predict the fast track protocol failure in cardiac surgery, are ASA class >3, NYHA class > III and operation time >267 min (8).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the single-lumen endotracheal tube and double-lumen endobronchial tube used in minimally invasive cardiac surgery for the fast track protocol

Kim

Baek

et al. 2016

J. Thorac. Dis.

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Background: Minimally invasive cardiac surgery (MICS) has been more commonly performed due to the reduced amount of bleeding and transfusion and length of hospital stay. We investigated the feasibility of performing MICS using single-lumen endotracheal tube (SLT). Methods: We conducted a retrospective review of clinical data of 112 patients who underwent MICS between July 2012 and March 2015. The patients underwent MICS using a SLT or a double lumen endotracheal tube (DLT). The duration of intensive care unit (ICU) stay and mechanical ventilation were recorded and analyzed. Results: Of the 96 patients, 50 were intubated with a SLT and 46 were intubated with a DLT. Anesthetic induction to skin incision time, surgical time and total anesthetic time were significant decreased in the SLT group (P<0.05). However, there was no difference in the duration of ICU stay and mechanical ventilation, and the incidence of extubation in operation room between the two groups. Conclusions: Comparing with insertion of a SLT, insertion of a DLT provided equivalent duration of ICU stay and mechanical ventilation after the MICS. Therefore, the type of inserted endotracheal tube would not influence on failure of the fast track protocol and insertion of a SLT is feasible and could be an alternative method to a DLT. that of a single-lumen endotracheal tube (SLT) and may be associated with airway trauma and bleeding (3). Postoperative airway swelling may also occur after using the DLT and the anesthesiologists may be in danger when exchanging a DLT to a SLT at the end of the surgery, even with the use of airway exchange catheters (4). Moreover, there are specific conditions in which a SLT may be preferred to a DLT, such as patients with previous oral or neck surgery who present with a challenging airway and require lung separation. Although one lung ventilation is important but not essential for MICS if it is possible that ventilation can be held or made intermittent both prior to CPB or at its conclusion to permit exposure (5).The cardiothoracic surgeons often consider that complications related with insertion of a DLT would result in failure or interference of the fast track protocol. The goal of this study is to investigate the feasibility of using a SLT compared with a DLT during anesthetic management in MICS and which method of lung deflation is appropriate for the fast tract protocol. MethodsAfter the Institutional Review Board approved, we conducted a retrospective review of clinical data of 112 patients who underwent MICS within about 3-year period beginning in July 2012 at Pusan National University Yangsan Hospital in Yangsan, Republic of Korea.Administering O 2 5 L/min for three minutes after standard monitors were applied to the patient and the anesthesia was induced using propofol (1-2 mg/kg), cisatracurium (0.2 mg/kg), remifentanil. Anesthesia was maintained by sevoflurane and remifentanil and the concentration of sevoflurane was adjusted to maintain the level of bispectral index as 40-60.Trained anesthesiologist inserted a ...

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Risk factor analysis for fast track protocol failure

Cited by 36 publications

References 31 publications

Spinal Anaesthesia and Perioperative Anxiety

Spinal Anaesthesia and Perioperative Anxiety

The Use of a Fast-Track Protocol for Perioperative Management of Cardiac Surgery Patients

Comparison of the single-lumen endotracheal tube and double-lumen endobronchial tube used in minimally invasive cardiac surgery for the fast track protocol

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