A FAST-TRACK PROTOCOL FOR CONVENTIONAL CARDIAC-SURGERY - EXPERIENCES OF A PILOT-STUDY

Early release after cardiac surgery can be promoted by implementation of a standard protocol for accelerated perioperative and early postope rative care, with optimal education and support of the patient playing a key role. We report on our preliminary experience with 100 selected patients who underwent a ''fast track'' protocol following coronary a rtery bypass (n = 61), valve replacement or reconstruction (n = 34) or closure of an atrial septal defect (n = 5) between 1996 and 1998. Sur gery was performed through a midline sternotomy using normothermic or mild hypothermic cardiopulmonary bypass. Patients undergoing cardiac s urgery with less invasive techniques were excluded from this study. Th e following criteria had to be fulfilled for early hospital discharge: sinus rhythm, temperature below 37.5 degrees C, stable haematocrit ar ound 0.30, uncomplicated wound healing and complete mobilisation inclu ding stair exercises. Mean duration of the operation was 137+/- 24 min utes and mean intubation time was 4.5+/-3 hours. Mean duration of hosp italisation from the day of the operation was 4.9+/-2.1 days. There wa s no early or late mortality in this group of patients and only 2 pati ents had to be re-admitted on postoperative day 10 and 14 because of a trial fibrillation in one and a wound healing problem in the other. Ac celerated recovery and early hospital discharge is highly attractive i n selected patients; it helps to promote early cardiac rehabilitation and the costs of the procedure can be substantially reduced. According to our experience and the most recent literature, this approach does not expose patients to higher mortality or morbidity. In addition, fas t-tracked patients have shown a higher level of satisfaction. Under op timal cooperation between surgery, anaesthesiology and intensive care unit, the fast-track protocol can be applied in approximately 30% of o verall adult cardiac surgery patients.