A CORONARY-ARTERY BYPASS FAST-TRACK PROTOCOL IS PRACTICAL AND REALISTIC IN A RURAL ENVIRONMENT

Background. In this study we determine retrospectively whether assignm ent ol: all patients undergoing coronary artery bypass grafting to a ' 'fast-track'' protocol (FT) is practical and realistic in our rural in stitution. Methods. We compared the outcome of 266 consecutive patient s undergoing coronary artery bypass grafting who were fast-tracked in 1996 with that of 266 consecutive patients who were managed convention ally (ITT) in 1994. The surgical techniques were comparable in both gr oups; however, FT anesthesia used inhalational agents and short-acting narcotics. All comparisons were performed using the Student's t test or the chi(2) test, Results. Postoperatively 95% of the FT group were extubated by 24 hours compared with O% in the NFT group (p < 0.0001). The mean intensive care unit length. of stay in the FT group was 1.7 /- 0.8 days, whereas it was 2.6 +/- 0.6 days in the NET group (p < 0.0 01). The mean postoperative length of stay was 6.4 +/- 1.2 days in the FT group compared with 7.5 +/- 0.9 days in the NFT group (p < 0.001). There were no significant differences ire 30-day morbidity/mortality. There was a substantial cost savings in the FT group. Conclusions. Th e fast-track protocol can be successful without any compromise of pati ent care. Early discharge front the hospital, however, is not always f easible. (C) 1997 by The Society of Thoracic Surgeons.