Fast-track recovery of the coronary bypass patient
| Autor: | Chester Humphrey, Joseph E. Flack, Philip D. Allmendinger, Richard M. Engelman, Penelope S. Pekow, Susannah G. Owen, David W. Deaton, Lee H. Ellison, John A. Rousou |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Time Factors media_common.quotation_subject Hemodynamics Coronary Disease Medicine Humans Derivation Postoperative Period Coronary Artery Bypass Survival rate Early discharge media_common Aged Retrospective Studies Ejection fraction business.industry Convalescence Retrospective cohort study Middle Aged Surgery Survival Rate Anesthesia Female Fast track Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 58(6) |
| ISSN: | 0003-4975 |
| Popis: | 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 (p0.01). This was accompanied by significant (p0.001) 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. |
| Databáze: | OpenAIRE |
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