Ultrafast-track extubation in cardiac surgery linked to lower postoperative complications, shorter ICU stay
Patients undergoing cardiac surgery who are extubated in the operating room, a strategy referred to as “ultrafast-track,” experience significantly fewer postoperative complications and shorter stays in the intensive care unit (ICU) compared to those who follow the conventional “fast-track” approach, according to a study.
The retrospective study included patients who underwent coronary, valve, or ascending aorta surgery. A total of 1126 patients were included in the analysis, with 579 (51.4%) being extubated in the operating room. The researchers employed propensity score matching to create 2 comparable groups: the ultrafast-track group, comprising patients extubated in the operating room, and the fast-track group, where extubation was attempted within the first 6 postoperative hours. After propensity score matching, the study yielded 331 pairs of patients for analysis.
The results revealed a difference in postoperative complications between the groups. The risk of the primary combined adverse event was significantly lower in the ultrafast-track group, at 6.3%, compared to 11.8% in the fast-track group (P = 0.013). This difference was predominantly driven by a reduction in lung adverse events (2.4% vs 6.9%). However, no statistically significant disparities were detected in the risk of death (1.8% vs 2.4%) or acute renal failure (6.3% vs 8%) between groups.
The study also found that patients in the fast-track group had a higher risk of myocardial infarction (2.7% vs 0%) compared to those in the ultrafast-track group. In addition, the median length of stay in the postoperative ICU was notably shorter for patients in the ultrafast-track group, with a median of 23.5 hours (IQR 22; 46), in contrast to 24.7 hours (IQR 21.5; 62.9) for those in the fast-track group.
Carnero-Alcázar M, Beltrao-Sial R, Montero-Cruces L, et al. Ultra Fast-Track Vs Conventional Fast-Track in Patients Undergoing Cardiac Surgery: A Propensity Score Matched Analysis. Interdiscip Cardiovasc Thorac Surg. 2023;ivad143. doi: 10.1093/icvts/ivad143. Epub ahead of print. PMID: 37607006.