FAST-TRACK RECOVERY OF THE CORONARY-BYPASS PATIENT

A new approach termed ''fast-track recovery'' was undertaken at both t he Baystate Medical Center and Hartford Hospital. The fast-track proto col involves the following principles: (1) preoperative education; (2) early extubation; (3) methylprednisolone sodium succinate before bypa ss followed by dexamethasone for 24 hours postoperatively; (4) prophyl actic digitalization, metoclopramide HCl, docusate sodium, and ranitid ine HCl; (5) accelerated rehabilitation; (6) early discharge; (7) a de dicated fast-track coordinator to perform both daily telephone contact and a 1-week postoperative examination; and (8) a routine 1-month pos toperative visit with a PA or MD. To evaluate the effects of this appr oach on patient care, a retrospective 1-year analysis was undertaken i n both institutions with all coronary artery bypass grafting patients compared in a consecutive manner before the origin of the fast-track p rotocol and subsequent to its beginning. There were 280 patients in th e fast-track and 282 in the non-fast-track group. The two groups were not significantly different except inexplicably there was a lower ejec tion fraction in the fast-track group and a longer cross-clamp time. P ostoperatively, the mean time to extubation decreased from 22.1 to 15. 4 hours, and peak weight gain decreased from 2.8 to 1.6 kg from the no n-fast-track to the fast-track group (p < 0.01). This was accompanied by significant (p < 0.001) decreases in intensive care unit duration f rom 2.4 to 1.9 days and in postoperative length of stay from 8.3 to 6. 8 days from the non-fast-track to the fast-track group. There was no i ncrease in morbidity or mortality associated with the fast-track proto col either early or late. Thirty-day hospital readmission was not sign ificantly different between the two groups. Fast-track methodology is effective, and we routinely employ this approach for all patients unde rgoing cardiopulmonary bypass.