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http://hdl.handle.net/1942/37931
Title: | Fast-Track Failure After Cardiac Surgery: Risk Factors and Outcome With Long-Term Follow-Up | Authors: | Hendrikx, Jore Timmers, Maxim AlTmimi, Layth Hoogma, Danny F. De Coster, Johan FIEUWS, Steffen Herijgers, Paul Rega, Filip Verbrugghe, Peter Rex, Steffen |
Issue Date: | 2022 | Publisher: | W B SAUNDERS CO-ELSEVIER INC | Source: | JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 36 (8) , p. 2463 -2472 | Status: | Early view | 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 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. | Notes: | Rex, S (corresponding author), Univ Hosp Leuven, Dept Anesthesiol, Herestr 49, B-3000 Leuven, Belgium. steffen.rex@uzleuven.be |
Keywords: | Fast-track;Enhanced recovery;Cardiac surgery | Document URI: | http://hdl.handle.net/1942/37931 | ISSN: | 1053-0770 | e-ISSN: | 1532-8422 | DOI: | 10.1053/j.jvca.2021.12.009 | ISI #: | WOS:000833407500003 | Rights: | 2021 Elsevier Inc. All rights reserved. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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