A Clinical and Economic Evaluation of Fast-Track Recovery after Cardiac Surgery

Salhiyyah, Kareem; Elsobky, Sherif; Raja, Shahzad G.; Attia, Rizwan; Brazier, John; Cooper, Graham

doi:10.1532/hsf98.20111029

Cited by 31 publications

(29 citation statements)

References 19 publications

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“…For low-risk cardiac surgical patients, transfer of these patients after surgery to a fast-track unit (19)(20)(21) instead of the ICU is safe and can increase throughput by 15% (20), increase ICU bed utilization (20), and is associated with an 8% reduction in perioperative care costs (21). Constantinides et al suggested that the application of the FTF risk model may facilitate planning and now of cardiac surgery, limit FTF rates and help reduce morbidity and cost (8).…”

Section: Discussionmentioning

confidence: 99%

Fast-Track Failure After Cardiac Surgery

Lee

Zhu

Underwood

et al. 2013

Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Fast-Track Failure After Cardiac Surgery

Lee

Zhu

Underwood

et al. 2013

Critical Care Medicine

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“…Besonders effizient ist die Frühmobilisation bei Einbettung in "Fast-Tracking"-Konzepte [7], die bereits für eine Vielzahl von operativen Prozeduren vorgestellt wurden. Sie ermöglichen den optimierten und somit schnelleren Durchlauf durch den gesamten perioperativen Prozess [93]. Neben dem bereits flächendeckenden Einsatz im ambulanten Bereich [106] könnten solche Fast-Track-Konzepte aber auch bei Hochrisikopatienten das perioperative Risiko vermindern [63].…”

Section: Pulmonale Komplikationunclassified

Perioperative risk and mortality after major surgery

et al. 2015

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Although anesthesia-associated mortality has been significantly reduced down to 0.00068-0.00082% over the last decades, recent studies have revealed a high perioperative mortality of 0.8- 4%. Apart from anesthesia and surgery-induced major complications, perioperative mortality is primarily negatively influenced by individual patient comorbidities. These risk factors predispose for acute critical incidents (e.g., myocardial infarction); however, the majority of fatal complications are a result of slowly progressing conditions, particularly infections or the sequelae of systemic inflammation. This implicates a broad window of opportunity for the detection and treatment of slow-onset complications to improve the perioperative outcome. The term "failure to rescue" (FTR), i.e., the proportion of patients who die from major complications compared to the number of all patients with complications, has been introduced as a valid indicator for the quality of perioperative care. Growing evidence has already shown that FTR is an underestimated factor in perioperative medicine accounting for or at least being involved in the development of postoperative mortality. While the incidence of severe postoperative complications amazingly does not show much variation between hospitals, FTR shows significant differences implying a major potential for improvement. With 14 million surgical procedures per year in Germany, a postoperative mortality of approximately 1% and an avoidable FTR rate of 40% mean that there are an estimated 60,000 preventable deaths per year. Hence, in the future it will be imperative to (1) identify patients at risk, (2) to prevent the development of postoperative complications with the use of adequate adjunctive therapeutic strategies, (3) to establish surveillance and monitoring systems for the early detection of postoperative complications and (4) to treat postoperative complications efficiently and in time when they arise.

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“…While enhanced recovery was initially developed for colorectal surgery, it has now been evaluated or adopted in a number of other surgeries, including radical cystectomy, hepatobiliary and pancreatic surgery, total knee replacement and cardiovascular surgery. [3][4][5][6][7] The management of an elderly patient undergoing surgery is an evolving challenge. In 2010, 524 million people were above the age of 65 years -8 percent of the world's population.…”

Section: Introductionmentioning

confidence: 99%

Suitability of Enhanced Recovery after Surgery (ERAS) Protocols for Elderly Colorectal Cancer Patients

Heng

2020

Smj

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Objective: Enhanced recovery after surgery (ERAS) provides a multimodal approach to postsurgical recovery, seeking to reduce a patient's stress response and promoting recovery. This study aimed to determine the suitability of ERAS protocols for elderly patients above 75 years of age. Methods: This is a retrospective analysis of all patients who had undergone major colorectal resections under ERAS protocols in Khoo Teck Puat Hospital, Singapore and Faculty of Medicine Siriraj Hospital, Thailand between 2013 and 2014. Data collected included patient characteristics and outcomes, including length of hospitalization, and time to first flatus and mobilization. Results: Of the 196 patients studied, 38 were above 75 years of age. Elderly patients were more likely to have more comorbidities, a higher ASA score and a higher POSSUM predicted mortality. They also had an increased risk of developing Clavien 2 complications (OR 2.41, 95% CI 1.10-5.29). Compared to their younger counterparts, elderly patients did not have a delay in first flatus or mobilization. However, they tended to stay longer (7.89 vs. 5.16 days, p<0.001). On multivariate analysis, ASA score of 3 and above was an independent risk factor for a length of stay over 1 week while age was not. Conclusion:This study has shown that elderly patients achieve comparable functional recovery under an enhanced recovery approach. Enhanced recovery after surgery can be adopted regardless of a patient's age.

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A Clinical and Economic Evaluation of Fast-Track Recovery after Cardiac Surgery

Abstract: Fast-track recovery after cardiac surgery decreases the intensive care LOS and the total duration of intubation. It is a cost-effective strategy compared with conventional recovery protocols; however, it does not reduce the total hospital LOS or the incidence of complications.

Cited by 31 publications

References 19 publications

Fast-Track Failure After Cardiac Surgery

Fast-Track Failure After Cardiac Surgery

Perioperative risk and mortality after major surgery

Suitability of Enhanced Recovery after Surgery (ERAS) Protocols for Elderly Colorectal Cancer Patients

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