HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Antonio Maria Calafiore Giovanni Teodori Gabriele Di Giammarco Giuseppe Vitolla Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Calafiore, A. M. Articles by Vitolla, G. Search for Related Content PubMed PubMed Citation Articles by Calafiore, A. M. Articles by Vitolla, G. Related Collections Coronary disease

Eur J Cardiothorac Surg 2002;21:377-384
© 2002 Elsevier Science NL

Day 0 intensive care unit discharge — risk or benefit for the patient who undergoes myocardial revascularization?

Department of Cardiology and Cardiac Surgery, ‘G. D'Annunzio’ University, Chieti, Italy

Received 12 September 2001; received in revised form 11 December 2001; accepted 11 December 2001.

* Corresponding address. Department of Cardiac Surgery, ‘San Camillo de' Lellis’ Hospital, Via Forlanini 50, 66100 Chieti, Italy. Tel.: +39-871-358653; fax: +39-871-402239
e-mail: calafiore{at}unich.it

Objective: Day 0 intensive care unit (ICU) discharge allows to use one ICU bed for two patients. Results of this policy were analysed. Methods: From January 1998 to June 2001, 1194 patients who had myocardial revascularization in the morning were discharged on the same day (Group 0, n=647), or one (Group 1, n=521) or many days (Group 2, n=26) after surgery. Criteria for day 0 discharge were: early extubation with at least 2 h of observation, stable hemodynamic status, no significant bleeding, no arrhythmias, normal EKG and normal neurological evolution. Results: Mean ICU stay was 4.0±1.2 h in Group 0, 17.5±4.0 h in Group 1 and 65.8±46.6 h in Group 2 (P₁, among Groups, <0.001; P₂, between Groups 0 and 1, <0.001). In 613 cases (94.7% of patients in Group 0) the same ICU bed was used for another patient. Postoperative in-hospital stay was 4.1±2.3 d in Group 0, 4.9±3.1 d in Group 1 and 7.4±6.8 in Group 2 (P₁<0.001; P₂<0.001). Fifteen patients (1.2%) were readmitted to the ICU, seven in Group 0 (1.1%), five in Group 1 (1.0%) and three (11.5%) in Group 2 (P₁<0.001, P₂ n.s.), because of bleeding (five cases in Group 0, two in Group 1, none in Group 2; P₁<0.001, P₂), cerebrovascular accident (two cases in Group 0, none in Group 1, three in Group 2; P₁<0.001, P₂ n.s.), acute myocardial infarction (no case in Groups 0 and 2, two in Group 1; P₁ n.s., P₂ n.s.) and acute renal failure (no case in Group 0 and 2, one case in Group 1; P₁ n.s., P₂ n.s.). Nine patients (0.8%) died (three, 0.5%, in Group 0, three, 0.6%, in Group 1 and three, 11.5%, in Group 2; P₁<0.001, P₂ n.s.), four (one in Group 0, two in Group 1 and one in Group 2, P₁ 0.006, P₂ n.s.) in the hospital (two from cardiac and two from non-cardiac causes) and five (two in Group 0, one in Group 1 and two in Group 2, P₁<0.001, P₂ n.s.) outside the hospital within the 30th day of surgery (one from cardiac and four from non-cardiac causes). No patient in Group 0 died from cardiac causes. Conclusions: Day 0 ICU discharge can be obtained in selected patients without an increased risk of death or of ICU readmission. The impact in terms of resource saving is striking.

Key Words: Fast track • Myocardial revascularization • ICU discharge in day 0

This article has been cited by other articles:

				J. Gooi, S. Marasco, M. Rowland, D. Esmore, J. Negri, and A. Pick Fast-Track Cardiac Surgery: Application in an Australian Setting Asian Cardiovasc Thorac Ann, April 1, 2007; 15(2): 139 - 143. [Abstract] [Full Text] [PDF]

				G. Di Giammarco, M. Pano, M. Giancane, A. Di Francesco, and M. Di Mauro Off-Pump Revascularization of Chronically Occluded Left Anterior Descending Artery Through Left Anterior Small Thoracotomy: Early and Late Angiographic and Clinical Follow-Up. Ann. Thorac. Surg., October 1, 2006; 82(4): 1446 - 1450. [Abstract] [Full Text] [PDF]

				G. Di Giammarco, M. Pano, M. Contini, P. Pelini, A. Di Francesco, M. Valente, and M. Di Mauro Left anterior small thoracotomy procedure MMCTS, August 9, 2005; 2005(0809): 778. [Abstract] [Full Text] [PDF]

				M. Flynn, S. Reddy, W. Shepherd, C. Holmes, D. Armstrong, C. Lunn, K. Khan, and S. Kendall Fast-tracking revisited: routine cardiac surgical patients need minimal intensive care Eur. J. Cardiothorac. Surg., January 1, 2004; 25(1): 116 - 122. [Abstract] [Full Text] [PDF]