Fast-Track Failure After Cardiac Surgery: Risk Factors and Outcome With Long-Term Follow-Up

被引:3
|
作者
Hendrikx, Jore [1 ]
Timmers, Maxim [1 ]
AlTmimi, Layth [1 ,2 ]
Hoogma, Danny F. [1 ,2 ]
De Coster, Johan [1 ]
Fieuws, Steffen [3 ]
Herijgers, Paul [2 ,4 ]
Rega, Filip [2 ,4 ]
Verbrugghe, Peter [2 ,4 ]
Rex, Steffen [1 ,2 ]
机构
[1] Univ Hosp Leuven, Dept Anesthesiol, Herestr 49, B-3000 Leuven, Belgium
[2] Katholieke Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium
[3] Katholieke Univ Leuven, Interuniv Inst Biostat & Stat Bioinformat, Leuven, Belgium
[4] Univ Hosp Leuven, Dept Cardiac Surg, Leuven, Belgium
关键词
Fast-track; Enhanced recovery; Cardiac surgery; INTENSIVE-CARE-UNIT; READMISSION; PREDICTORS; RECOVERY;
D O I
10.1053/j.jvca.2021.12.009
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
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 Main Results: 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, cadiac 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. (C) 2021 Elsevier Inc. All rights reserved.
引用
收藏
页码:2463 / 2472
页数:10
相关论文
empty
未找到相关数据