Fast-track Cardiac Surgery in Children: Feasibility in Bangladeshi Setting

Abstract

Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner. Keywords: Cardiac surgery; Congenital heart disease; Fast track; Hospital discharge. DOI: 10.3329/cardio.v3i1.6427Cardiovasc. j. 2010; 3(1): 50-54

On-table Extubation after Open Heart Surgery in Children: An Experience from a Tertiary Care Hospital in a Developing Country

“…Arrhythmia was previously reported in one study with wound sepsis being reported fairly more commonly but with nonfatal results and with no obvious link to OTE . Our mean length of stay in the CICU is also comparable with other studies that show a reduced length of stay between 1 and 3 days . Alghamdi et al.…”

“…11,15 Our mean length of stay in the CICU is also comparable with other studies that show a reduced length of stay between 1 and 3 days. [6][7][8]19,21 Alghamdi et al showed in a systematic review and meta-analysis a reduction in length of ICU and hospital stay without adverse effects on respiratory morbidity or overall mortality. Early extubation in pediatric congenital cardiac surgery from a center in a developing country is desirable due to the fact that specialized intensive care facilities are in short supply, and saving a few hours on the ventilator in the postoperative period may lead to significant cost savings as shown in two prospective trials and a review by Mittnacht et al 11,21,22 Heinle et al documented a cost reduction of $21 108 ± $14 941 vs. $31 608 ± $9861 ( Table 2).…”

“…Cost of care in the PICU may largely be affected by infections and a short stay in the PICU will lead to a lower infection rate and hence a lower cost while also leading to a more favorable outcome in children undergoing congenital cardiac surgery . To our knowledge, there are reported experiences of OTE in pediatric patients undergoing congenital heart surgery from very few developing countries, namely India and Bangladesh and none from Pakistan. Both studies showed no need for re‐intubation and a reduced length of PICU stay.…”

Perioperative Care Pathways in Low‐ and Lower‐Middle‐Income Countries: Systematic Review and Narrative Synthesis

“…Minimizing the length of hospital stay was therefore hoped to reduce costs for the family. Conversely, a study from Bangladesh described that lack of follow‐up services outside the city led patients in the ‘fast track’ pathway to stay near the hospital for at least a week post‐discharge [42].…”

“…Cooperation and good team communication were reported as facilitators to implementation [25, 27]. High demand for surgery, performance indicators and the need for efficient use of limited resources created tension for change away from existing care [25, 42, 50]. Two Indian studies conducted in specialized hospitals acknowledged that their existing resources were not representative of most LMIC institutions, where resource constraints could act as a barrier [30, 34].…”