Ultra-fast track hospital discharge using conventional cardiac surgical techniques

Background. Recent introduction of minimally invasive adult cardiac surgica l techniques has emphasized the advantage of early hospital discharge. Howe ver, we chose an alternative approach to determine the safety, efficacy, an d feasibility of ultra-fast track protocols while retaining both standard s urgical exposure (median sternotomy) and conventional cardiac surgical tech niques (hypothermia, cardiopulmonary bypass with cardiac arrest, and optima l myocardial protection). Methods. From September 1995 to January 1998, a total of 258 consecutive pa tients underwent cardiac procedures by a single surgeon. Acceleration of cl inical pathways was used to initiate earlier discharges. Stringent postdisc harge follow-up was implemented. Prospectively entered data were then analy zed retrospectively. Results. A variety of isolated as well as combined coronary and valve proce dures were performed. Of the 258 patients ,perated on during this entire st udy period, a total of 144 patients (56%) were discharged within postoperat ive days 1 to 4 (ultra-fast track discharge). Over the past 12 months, this incidence increased to 70% (76 of 108 patients). Approximately 50% of thes e patients were operated on urgently or emergently. To date, there have bee n no deaths in this ultra-fast track group. There were eight brief readmiss ions, of which one was for rewiring of a noninfected sternal dehiscence, an d the remaining were for cardiac diagnostic studies or a noncardiac problem altogether. Conclusions. Conventional cardiac operation can allow ultrafast hospital di scharges while retaining the advantage of time-tested techniques and provid ing wider application without requiring new or additional training or equip ment. (C) 1999 by The Society of Thoracic Surgeons.