FAST-TRACK RECOVERY OF THE CORONARY-BYPASS PATIENT

被引:289
作者
ENGELMAN, RM
ROUSOU, JA
FLACK, JE
DEATON, DW
HUMPHREY, CB
ELLISON, LH
ALLMENDINGER, PD
OWEN, SG
PEKOW, PS
机构
[1] HARTFORD HOSP,HARTFORD,CT 06115
[2] UNIV CONNECTICUT,SCH MED,FARMINGTON,CT
[3] UNIV MASSACHUSETTS,SCH PUBL HLTH,AMHERST,MA 01003
关键词
D O I
10.1016/0003-4975(94)91674-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A new approach termed ''fast-track recovery'' was undertaken at both the Baystate Medical Center and Hartford Hospital. The fast-track protocol involves the following principles: (1) preoperative education; (2) early extubation; (3) methylprednisolone sodium succinate before bypass followed by dexamethasone for 24 hours postoperatively; (4) prophylactic digitalization, metoclopramide HCl, docusate sodium, and ranitidine HCl; (5) accelerated rehabilitation; (6) early discharge; (7) a dedicated fast-track coordinator to perform both daily telephone contact and a 1-week postoperative examination; and (8) a routine 1-month postoperative visit with a PA or MD. To evaluate the effects of this approach on patient care, a retrospective 1-year analysis was undertaken in both institutions with all coronary artery bypass grafting patients compared in a consecutive manner before the origin of the fast-track protocol and subsequent to its beginning. There were 280 patients in the fast-track and 282 in the non-fast-track group. The two groups were not significantly different except inexplicably there was a lower ejection fraction in the fast-track group and a longer cross-clamp time. Postoperatively, 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 non-fast-track to the fast-track group (p < 0.01). This was accompanied by significant (p < 0.001) decreases in intensive care unit duration from 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 increase in morbidity or mortality associated with the fast-track protocol either early or late. Thirty-day hospital readmission was not significantly different between the two groups. Fast-track methodology is effective, and we routinely employ this approach for all patients undergoing cardiopulmonary bypass.
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收藏
页码:1742 / 1746
页数:5
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