Coronary artery bypass grafting “On Pump”: role of three-day discharge

Ott, Richard A.; Gutfinger, Dan; Miller, Mark; Selvan, Arthur; Codini, Michele A.; Alimadadian, Hossein; Tanner, Teresa M.

doi:10.1016/s0003-4975(97)00542-0

Cited by 23 publications

(6 citation statements)

References 12 publications

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“…Enfin, la réanimation post-opératoire basée sur la prévention et la détection des complications et une stratégie efficace et précoce de l’analgésie aboutissant à l’extubation précoce constitue le dernier maillon d’une chaîne de soins dont l’équilibre est précaire et où toute défaillance pourrait amener l’équipe de soins à renoncer à la stratégie de Fast-tracking. Si la pratique du Fast-tracking en Amérique du nord et en Europe remonte à plusieurs années [ 2 ], son application dans d’autres pays [ 3 ] et particulièrement en Tunisie ne date que de peu de temps. Nous nous proposons dans ce travail d’analyser les pratiques relatives aux parcours rapides en chirurgie cardiaque adulte programmée au CHU.…”

Section: Introductionunclassified

L’effet de l’extubation precoce apres chirurgie cardiaque pour la rehabilitation post opératoire

Cheikhrouhou¹,

Kharrat²,

Derbel³

et al. 2017

Pan Afr Med J

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RésuméIntroductionLa réhabilitation post opératoire en chirurgie cardiaque est basée sur une prise en charge médico-chirurgicale visant à diminuer la durée de séjour hospitalier et les coûts de soins de cette chirurgie à haut risque. L’extubation trachéale précoce, définie par une extubation avant la sixième heure, constitue la pierre angulaire du Fast-tracking. L’objectif de notre étude est d’évaluer dans notre institution la pratique du fast-track et notamment de l’extubation trachéale précoce en chirurgie cardiaque adulte programmée.MéthodesNous avons conduit une étude descriptive incluant tous les patients âgés de plus 18 ans opérés consécutivement d’une chirurgie cardiaque programmée et qui ont été pris en charge en post-opératoire dans l’unité de réanimation post-opératoire du Service de chirurgie thoracique et cardiovasculaire du CHU HABIB BOURGUIBA de SFAX. Les critères d’inclusion des malades: âgés de 18 ans et plus, opérés d’une chirurgie cardiaque programmée, dont la prise en charge post-opératoire s’est faite dans l’unité de réanimation post-opératoire du service de chirurgie cardio-vasculaire et thoracique. Notre protocole d’anesthésie a été standardisé pour tous les patients: Propofol, Rémifentanil, Cisatracrium. Nous avons noté le délai d’extubation en post opératoire et les facteurs qui allongent ce délai d’extubation.RésultatsNous avons colligé 200 observations de malades consécutifs qui ont bénéficié d’une chirurgie cardiaque programmée. Parmi ces malades 115 étaient opérés pour pontage aorto-coronaire, 79 pour chirurgie valvulaire et 6 pour chirurgie combinée ou autre. Les caractéristiques démographiques sont comparables. En post-opératoire, nous avons pu extuber 152 soit 76% de nos malades avant la sixième heure. Quarante-huit patients n’ont pas pu être extubés avant la sixième heure. Les principales causes de l’échec de l’extubation précoce sont : fortes doses de catécholamines, saignement, arythmie et les troubles neurologiques.ConclusionNous avons pu démontrer que la réalisation de la réhabilitation post opératoire était possible dans notre institution et tous les patients bénéficiant d’une chirurgie cardiaque réglée devraient être candidats à l’extubation précoce.

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Section: Introductionunclassified

L’effet de l’extubation precoce apres chirurgie cardiaque pour la rehabilitation post opératoire

Cheikhrouhou¹,

Kharrat²,

Derbel³

et al. 2017

Pan Afr Med J

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“…POAF is a well‐known complication following cardiac surgery with reports ranging from 10% to 65% and has been associated with increased morbidity, mortality, and overall resource utilization 3–7 . Our overall POAF rate was on the lower end at 15%, which could be due to a relatively young population.…”

Section: Resultsmentioning

confidence: 72%

Outcomes of 3‐day discharge after elective cardiac surgery

et al. 2021

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Background Shorter length of stay (LOS) is a welcome consequence of optimized perioperative care. However, accelerated hospital discharge may have unintended consequences. Before implementing an institutional enhanced recovery after surgery protocol, we evaluated the safety of shorter LOS and compared outcomes of patients with shorter LOS (LOS ≤ 3 days) to those with longer LOS (LOS > 3 days). Methods We identified all patients undergoing elective cardiac surgery with cardiopulmonary bypass between July 2004 and June 2017. Transcatheter approaches, ventricular assist devices, transplants, and traumas were excluded. Patients were divided into two cohorts, one with shorter hospitalizations (LOS ≤ 3 days) and one with longer hospitalizations (LOS > 3 days). Propensity score matching (PSM) was performed and differences between the two groups were compared. Results A total of 5,987 patients (63.0 ± 13.8 years old, 34% female) were identified and 131 (2.2%) patients were LOS ≤ 3 days; median STS Risk score was 1.2 (0.6–2.4). PSM resulted in a total of 478 patients (357 LOS > 3 and 121 LOS ≤ 3 days); median STS Risk score was 0.4 (0.3–0.9). LOS ≤ 3 days had lower rates of postoperative atrial fibrillation (2% vs. 19%; p < .001) and major in‐hospital complications (0% vs. 9%; p = .001); however, 30‐day readmissions (8% LOS ≤ 3 vs. 6% LOS > 3 days; p = .66) and mortality rates (0% vs. 0%) were comparable between the two groups. Conclusion LOS ≤ 3 days was associated with less postoperative atrial fibrillation and fewer major in‐hospital complications. LOS ≤ 3 days was not associated with rehospitalization or mortality. Shorter LOS after elective cardiac surgery appears to be a safe practice with favorable outcomes, especially in low operative risk patients.

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“…We also reported on rapid recovery in the elderly, 3 and in octogenarians," as well as identifying patients eligible for 3-day discharge. 13 Our methods differed from those of previous reports by emphasizing short CPB time, preoperative IABP criteria for high-risk patients," and postoperative atrial fibrillation prevention. ': II This effort has produced a method that minimizes the negative aspects of CABG with CPB.…”

Section: Table 4 Mortality and Postoperative Complicationsmentioning

confidence: 84%

“…Under the fast-track method, all patients followed a protocol emphasizing a short pump time, early extubation, aggressive preoperative intra-aortic balloon pump (lABP) criteria, and an atrial fibrillation prevention protocol. [11][12][13] Group A patients were then compared with two groups of patients (Groups B and C). Group B consisted of 29 patients who underwent singlevessel CABG (internal mammary artery to left anterior descending coronary artery) using a minimally invasive direct coronary artery bypass (MIDCAB) technique.…”

Section: Methodsmentioning

confidence: 99%

Initial Experience with Beating Heart Surgery: Comparison with Fast-Track Methods

Ott

Gutfinger

Steedman

et al. 1999

The American Surgeon

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Cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG) may increase postoperative complications in high-risk patients. The goal of this study is to retrospectively review a series of consecutive patients undergoing conventional CABG using a fast-track recovery method and to compare this series with the initial series of patients undergoing beating heart surgery using either the single-vessel minimally invasive approach or the off-pump multivessel bypass technique with a median sternotomy. One hundred fifty-eight consecutive patients underwent CABG. One hundred four patients underwent conventional CABG using CPB with a short-pump fast-track recovery method (Group A). Twenty-nine patients underwent a single-vessel bypass via a left anterior thoracotomy off pump [Group B, minimally invasive direct coronary artery bypass (MIDCAB)]. Twenty-five patients underwent multivessel CABG with a median sternotomy off pump (Group C). Short-pump fast-track (Group A) patients exhibited minimal complications and expedient recovery and received extensive revascularization. Off-pump multivessel patients (Group C) received fewer bypass grafts, had more preoperative comorbidity, and recovered as quickly as lower-risk fast-track short-pump patients (Group A). Single-vessel off-pump patients (Group B, MIDCAB) were younger elective patients and demonstrated no recovery advantage. The overall mortality was 1.8 per cent. The conversion rates from beating heart surgery to CPB for groups B and C were 10.3 and 16 per cent, respectively. The postoperative hospital length of stay for groups A, B, and C were 4.8 ± 2.4, 3.9 ± 1.8, and 5.2 ± 2.3 days, respectively. Eliminating CPB is not as important as reducing exposure for minimizing operative risk. Beating heart surgery is an adjunct to conventional CABG with CPB. The off-pump multivessel bypass technique is best suited for high-risk patients requiring three grafts or fewer, whereas MIDCAB is best suited for single-vessel bypass that cannot be managed using interventional percutaneous techniques; however, the recovery advantage with MIDCAB is not apparent. Patients requiring more than three bypass grafts should undergo conventional CABG with CPB.

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Coronary artery bypass grafting “On Pump”: role of three-day discharge

Cited by 23 publications

References 12 publications

L’effet de l’extubation precoce apres chirurgie cardiaque pour la rehabilitation post opératoire

L’effet de l’extubation precoce apres chirurgie cardiaque pour la rehabilitation post opératoire

Outcomes of 3‐day discharge after elective cardiac surgery

Initial Experience with Beating Heart Surgery: Comparison with Fast-Track Methods

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