Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery

Autor: Sara Mele, Giulia Costola, TC Aw, Andrew Constantine, Konstantinos Dimopoulos, Darryl F. Shore, Paolo Bianchi
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Time Factors
medicine.medical_treatment
030204 cardiovascular system & hematology
coarsened exact matching
law.invention
0302 clinical medicine
law
early extubation
health economics
health outcomes
Postoperative Period
1102 Cardiorespiratory Medicine and Haematology
Original Research
Cardiovascular Surgery
Quality and Outcomes
propensity score matching
Congenital Heart Disease
Health Services
Intensive care unit
Cardiac surgery
Costs and Cost Analysis
Female
Cardiology and Cardiovascular Medicine
cardiac surgery
Adult
Heart Defects
Congenital
medicine.medical_specialty
Critical Care
03 medical and health sciences
medicine
adult congenital heart disease
Weaning
Humans
Diseases of the circulatory (Cardiovascular) system
Ultra fast
Cardiac Surgical Procedures
Retrospective Studies
Mechanical ventilation
Cardiopulmonary Resuscitation and Emergency Cardiac Care
Health economics
business.industry
Track (disk drive)
Length of Stay
030228 respiratory system
RC666-701
Propensity score matching
Emergency medicine
Airway Extubation
Cost-Effectiveness
business
Follow-Up Studies
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 11 (2021)
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background In pediatric cardiac surgery, perioperative management has evolved from slow weaning of mechanical ventilation in the intensive care unit to “ultra‐fast‐track” anesthesia with early extubation (EE) in theater to promote a faster recovery. The strategy of EE has not been assessed in adults with congenital heart disease, a growing population of patients who often require surgery. Methods And Results Data were collected retrospectively on all patients >16 years of age who underwent adult congenital heart surgery in our tertiary center between December 2012 and January 2020. Coarsened exact matching was performed for relevant baseline variables. Overall, 711 procedures were performed: 133 (18.7%) patients underwent EE and 578 (81.3%) patients received conventional extubation. After matching, patients who received EE required less inotropic or vasopressor support in the early postoperative period (median Vasoactive‐inotropic score 0.5 [0.0–2.0] versus 2.0 [0.0–3.5]; P P =0.0002). The overall reintubation rate was low at 0.3%. EE was associated with a significantly shorter postoperative length of stay in higher dependency care units before a “step‐down” to ward‐based care (48 [45–50] versus 50 [47–69] hours; P =0.004). Lower combined intensive care unit and high dependency unit costs were incurred by patients who received EE compared with patients who received conventional extubation (£3949 [3430–4222] versus £4166 [3893–5603]; P Conclusions In adult patients undergoing surgery for congenital heart disease, EE is associated with a reduced need for postoperative hemodynamic support, a shorter intensive care unit stay, and lower health‐care‐related costs.
Databáze: OpenAIRE
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