Fast tracking in cardiac surgery: is it safe?
| dc.contributor.author | MacLeod, Jeffrey B. | |
| dc.contributor.author | D’Souza, Kenneth | |
| dc.contributor.author | Aguiar, Christie | |
| dc.contributor.author | Brown, Craig D. | |
| dc.contributor.author | Pozeg, Zlatko | |
| dc.contributor.author | White, Christopher | |
| dc.contributor.author | Arora, Rakesh C. | |
| dc.contributor.author | Légaré, Jean-François | |
| dc.contributor.author | Hassan, Ansar | |
| dc.date.accessioned | 2022-05-01T03:21:12Z | |
| dc.date.issued | 2022-04-06 | |
| dc.date.updated | 2022-05-01T03:21:13Z | |
| dc.description.abstract | Abstract Background While fast track clinical pathways have been demonstrated to reduce resource utilization in patients undergoing cardiac surgery, it remains unclear as to whether they adversely affect post-operative outcomes. The purpose of this study was to determine the impact of fast tracking on post-operative outcomes following cardiac surgery. Methods In a retrospective study, all patients undergoing first-time, on-pump, non-emergent coronary artery bypass grafting, valve, or coronary artery bypass grafting + valve at a single centre between 2010 and 2017 were included. Patients were considered to have been fast tracked if they were extubated and transferred from intensive care to a step-down unit on the same day as their procedure. The risk-adjusted effect of fast tracking on a 30-day composite of all-cause mortality, stroke, renal failure, infection, atrial fibrillation, and readmission to hospital was determined. Furthermore, propensity score matching was used to match fasting track patients in a 1-to-1 manner with their nearest “neighbor” in the control group and subsequently compared in terms of 30-day post-operative outcomes. Results 3252 patients formed the final study population (fast track: n = 245; control: n = 3007). Patients who were fast tracked experienced reduced time to initial extubation (4.3 vs. 5.6 h, p < 0.0001) and lower median initial intensive care unit length of stay (7.8 vs. 20.4 h, p < 0.0001). Fast tracked patients experienced lower 30-day rates of the composite outcome (42.4% vs. 51.5%, p = 0.008). However, following propensity score matching, fast tracked patients experienced similar 30-day rates of the composite outcome as the control group (42.4% vs. 44.5%, p = 0.72). After risk adjustment using multivariable regression modeling, fast tracking was predictive of an improved 30-day composite outcome (OR 0.75, 95% CI 0.57–0.98, p = 0.03). Conclusion Fast track clinical pathways was associated with reduced intensive care unit, overall length of stay and similar 30-day post-operative outcomes. These results suggest that fast tracking appropriate patients may reduce resource utilization, while maintaining patient safety. Graphical abstract | |
| dc.identifier.citation | Journal of Cardiothoracic Surgery. 2022 Apr 06;17(1):69 | |
| dc.identifier.uri | https://doi.org/10.1186/s13019-022-01815-9 | |
| dc.identifier.uri | http://hdl.handle.net/1993/36450 | |
| dc.language.rfc3066 | en | |
| dc.rights | open access | en_US |
| dc.rights.holder | The Author(s) | |
| dc.title | Fast tracking in cardiac surgery: is it safe? | |
| dc.type | Journal Article | |
| local.author.affiliation | Rady Faculty of Health Sciences | en_US |