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CARDIOVASCULAR ANESTHESIOLOGY

Fast-Track Anesthesia and Cardiac Surgery: A Retrospective Cohort Study of 7989 Patients

Vesna Svircevic, MD^*, Arno P. Nierich, MD, PhD, Karel G. M. Moons, PhD^*, George J. Brandon Bravo Bruinsma, MD, PhD, Cor J. Kalkman, MD, PhD^*, and Diederik van Dijk, MD, PhD^*||

From the *Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Anesthesiology, Isala Clinics, Groot Weezenland 20, Zwolle, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, Isala Clinics, Groot Weezenland 20, Zwolle, The Netherlands; and ||Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.

Address correspondence and reprint requests to Diederik van Dijk, MD, PhD, Division of Perioperative Care and Emergency Medicine, Department of Intensive Care, University Medical Center Utrecht, Mailstop Q 04.460, PO Box 85500, 3508 GA Utrecht, The Netherlands. Address e-mail to D.vanDijk{at}umcutrecht.nl.

Abstract

BACKGROUND: Fast-track cardiac anesthesia (FTCA) has been widely implemented but its safety has not been evaluated in sufficiently powered studies.

METHODS: We compared outcomes of patients undergoing FTCA with a historical control group undergoing conventional high-dose opioid cardiac anesthesia (CCA). The primary outcome measure was the incidence of in-hospital mortality. Secondary outcome measures were the incidence of in-hospital acute myocardial infarction, renal failure, and stroke. We also compared duration of mechanical ventilation and length of hospitalization in the intensive care unit and postoperative ward.

RESULTS: The CCA group comprised 4020 patients and the FTCA Group 3969 patients. The patients in the FTCA group were slightly older, had more comorbidities, and were more likely to undergo valve surgery than the CCA group. The incidence of in-hospital mortality was 1.9% in the CCA group and 2.3% in the FTCA group. Compared with the CCA group, the crude odds ratio for mortality in the FTCA group was 1.20 (95% confidence interval 0.88–1.64, P = 0.25) and the adjusted odds ratio was 0.92 (95% confidence interval, 0.65–1.32, P = 0.66). The incidence of myocardial infarction and stroke in the CCA and FTCA groups were 5.2% and 5.5% (P = 0.61), and 0.9% and 1.3%, (P = 0.06), respectively, whereas the incidence of acute renal failure was similar in both groups (0.8%, P = 0.84). The duration of mechanical ventilation was shorter in the FTCA patients compared with the CCA group (6 vs 12 h, P 0.001), but their median intensive care stay was 1 h longer (23 vs 22 h, P 0.001). Although the median duration of hospitalization was 6.0 days in both groups, the 90th percentile of the hospitalization time was 13 days in the CCA group and 18 days in the FTCA group (P 0.001).

CONCLUSIONS: These data from 7989 cardiac surgical patients showed no evidence of an increased risk of adverse outcomes in patients undergoing FTCA.

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				B. S. Silbert and P. S. Myles Is Fast-Track Cardiac Anesthesia Now the Global Standard of Care? Anesth. Analg., March 1, 2009; 108(3): 689 - 691. [Full Text] [PDF]