Fast-Track Failure After Cardiac Surgery: Risk Factors and Outcome With Long-Term Follow-Up.
J Cardiothorac Vasc Anesth
; 36(8 Pt A): 2463-2472, 2022 08.
Article
en En
| MEDLINE
| ID: mdl-35031218
ABSTRACT
OBJECTIVES:
An important cornerstone of the Enhanced Recovery After Cardiac Surgery initiative is a fast-track cardiac anesthesia management protocol. Fast-track failure has been described to have a detrimental impact on immediate postoperative outcomes. The authors here evaluated risk factors for short- and long-term effects of fast-track failure.DESIGN:
A retrospective cohort study.SETTING:
A single academic center.PARTICIPANTS:
Adult cardiac surgery was performed on 7,064 patients between January 2013 and October 2019. INTERVENTION The inclusion criteria for the fast-track program at the postanesthesia care unit were met by 1,097 patients. MEASUREMENTS AND MAINRESULTS:
Univariate and multivariate logistic regression analyses were used to identify independent risk factors. Fast-track failure occurred in 69 (6.3%) patients. These were associated with significant increases in the incidences of coronary revascularization, cardiac tamponade or bleeding requiring surgical intervention, new-onset atrial fibrillation, pneumonia, delirium, and sepsis. Likewise, the postoperative length of stay, and up to 5-year mortality, were significantly higher in the fast-track failure than the nonfailure group. The European System for Cardiac Operative Risk Evaluation II and transfusion of any blood product could be identified as independent risk factors for fast-track failure, with only limited discriminative ability (area under the curve = 0.676; 95% confidence interval, 0.611-0.741).CONCLUSION:
Fast-track failure is associated with increases in morbidity and long-term mortality, but remains difficult to predict.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Procedimientos Quirúrgicos Cardíacos
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Humans
Idioma:
En
Año:
2022
Tipo del documento:
Article