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): Cem Alhan Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Alhan, C. Articles by Caglar, N. Search for Related Content PubMed PubMed Citation Articles by Alhan, C. Articles by Caglar, N. Related Collections Cardiac - other Coronary disease

Eur J Cardiothorac Surg 2003;23:678-683
© 2003 Elsevier Science NL

Fast track recovery of high risk coronary bypass surgery patients

Cem Alhan*, Fevzi Toraman, Esref Hasan Karabulut, Sümer Tarcan, Sinan Dadelen, Nevnihal Eren, Nuri Calar

^a Department of Cardiovascular Surgery, Acibadem Kadikoy Hospital, Istanbul, Turkey

Received 16 September 2002; received in revised form 4 January 2003; accepted 10 January 2003.

^* Corresponding author. Acibadem, Sebboylu Sok. 2/8, Mashar Bey Ap., 81010, Kadikoy, Istanbul, Turkey. Tel.: +216-5444124; fax: +216-3258759
e-mail: cemalhan{at}superonline.com

Objective: Fast track recovery protocols on younger, low risk patients result in shorter hospital stays and decreased costs. However, data is lacking on the impact of these protocols on high risk patients based on an objective scoring system. Methods: In this study, a high risk cohort of patients (EuroSCORE 6, n=158) was compared with a low risk cohort of patients (EuroSCORE <6, n=1004) to define the safety and efficacy of fast track recovery among high risk patients. A standard perioperative data is collected prospectively for every patient. Results: Time to extubation was longer in the high risk group (299±253 vs. 232±256 min; P=0.003), but intensive care unit (ICU) stay (25.6±28.7 vs. 21.5±9.4 h; P=ns), and postoperative length of stay (5.8±2.4 vs. 5.6±2.7 days; P=ns) was similar when compared with the low risk group. Of the high risk patients 81% were extubated within 6 h, 87% were discharged from the intensive care unit within 24 h, and 67% were discharged from the hospital within 5 days. Multiple regression analysis showed that any red blood cell transfusion (P=0.02), and cross clamp time >60 min (P=0.03) were the predictors of delayed extubation (6 h) in the high risk group. The predictors of extended ICU stay were any red blood cell transfusion (P=0.0001), and peripheral vascular disease (P=0.05). Any red blood cell transfusion was the only predictor for mortality (P=0.02) and readmission to the hospital within the first 30 days (P=0.02) in this cohort of patients. Conclusions: This study confirms the safety and efficacy of fast track recovery protocol among high risk patients undergoing coronary artery bypass surgery. All patients are basically suitable for fast track recovery and the preoperative risk factors are poor predictors of prolonged ventilation, increased ICU and hospital stay. Red blood cell transfusion is associated with delayed extubation and discharge from the ICU, and increased mortality and hospital readmission rate.

Key Words: Coronary artery bypass grafting • High risk • Fast track recovery

This article has been cited by other articles:

				K. Doddakula, N. Al-Sarraf, K. Gately, A. Hughes, M. Tolan, V. Young, and E. McGovern Predictors of acute renal failure requiring renal replacement therapy post cardiac surgery in patients with preoperatively normal renal function Interactive CardioVascular and Thoracic Surgery, June 1, 2007; 6(3): 314 - 318. [Abstract] [Full Text] [PDF]