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The Annals of Thoracic Surgery, Vol 58, 1742-1746, Copyright © 1994 by The Society of Thoracic Surgeons
RM Engelman, JA Rousou, JE Flack 3rd, DW Deaton, CB Humphrey, LH Ellison, PD Allmendinger, SG Owen and PS Pekow
A new approach termed "fast-track recovery" ws undertaken at both the
Baystate Medical Center and Hartford Hospital. The fast-track protocol
involves the following principles: (1) preoperative education; (2) early
extubation; (3) methylprednisolone sodium succinate before bypass followed
by dexamethasone for 24 hours postoperatively; (4) prophylactic
digitalization, metoclopramide HCl, docusate sodium, and ranitidine HCl;
(5) accelerated rehabilitation; (6) early discharge; (7) a dedicated
fast-track coordinator to perform both daily telephone contact and a 1-week
postoperative examination; and (8) a routine 1- month postoperative visit
with a PA or MD. To evaluate the effects of this approach on patient care,
a retrospective 1-year analysis was undertaken in both institutions with
all coronary artery bypass grafting patients compared in a consecutive
manner before the origin of the fast-track protocol and subsequent to its
beginning. There were 280 patients in the fast-track and 282 in the
non-fast-track group. The two groups were not significantly different
except inexplicably there was a lower ejection fraction in the fast-track
group and a longer cross- clamp time. Postoperatively, the mean time to
extubation decreased from 22.1 to 15.4 hours, and peak weight gain
decreased from 2.8 to 1.6 kg from the non-fast-track to the fast-track
group (p < 0.01). This was accompanied by significant (p < 0.001)
decreases in intensive care unit duration from 2.4 to 1.9 days and in
postoperative length of stay from 8.3 to 6.8 days from the non-fast-track
to the fast-track group. There was no increase in morbidity or mortality
associated with the fast- track protocol either early or late. Thirty-day
hospital readmission was not significantly different between the two
groups. Fast-track methodology is effective, and we routinely employ this
approach for all patients undergoing cardiopulmonary bypass.
ARTICLES
Fast-track recovery of the coronary bypass patient
Department of Surgery, Baystate Medical Center, Springfield, Massachusetts 01199.
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D. C. H. Cheng, J. Karski, C. Peniston, B. Asokumar, G. Raveendran, J. Carroll, H. Nierenberg, S. Roger, D. Mickle, J. Tong, et al. MORBIDITY OUTCOME IN EARLY VERSUS CONVENTIONAL TRACHEAL EXTUBATION AFTER CORONARY ARTERY BYPASS GRAFTING: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL J. Thorac. Cardiovasc. Surg., September 1, 1996; 112(3): 755 - 764. [Abstract] [Full Text]
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R. M. Engelman, J. A. Rousou, J. E. Flack III, D. W. Deaton, R. Kalfin, and D. K. Das Influence of Steroids on Complement and Cytokine Generation After Cardiopulmonary Bypass Ann. Thorac. Surg., September 1, 1995; 60(3): 801 - 804. [Abstract] [Full Text]
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N. M. Katz, R. L. Hannan, R. A. Hopkins, and R. B. Wallace Cardiac Operations in Patients Aged 70 Years and Over: Mortality, Length of Stay, and Hospital Charge Ann. Thorac. Surg., July 1, 1995; 60(1): 96 - 100. [Abstract] [Full Text]
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