Abstract
Objectives: Early extubation (EE) has become a critical determinant in perioperative management following congenital heart surgery (CHS). Fast track (FT) strategies and EE, when feasible, can have beneficial effects on clinical outcomes. We sought to determine clinical and cost implications related to FT during infancy and identify predictors of failure.
Methods: Between January 2017–December 2018 112 consecutive infants underwent CHS. Patients with Society of Thoracic Surgeons/European Association of Cardiothoracic Surgery CHS Complexity Categories (STAT) 1–5 were followed from the index operation until hospital discharge and included in the study. Patients with tracheostomy needing mechanical ventilation prior to CHS, preoperative ECMO support, non-index STAT case were excluded. Groups were identified as (A):EE/Fast track and (B):no EE. Determinants for EE failure were assessed and cost analysis pursued.
Results: Eighty-one (72%) had successful fast track/EE. Premature neonates and chromosomal anomalies/syndromes were less likely to follow EE path (p < 0.05) and STAT complexity (4–5) unsuitable for fast track (p < 0.05). Vasoactive-Inotropic score was not statistically different between groups (p > 0.05). ICU length of stay was directly correlated with EE/Fast track and longer for single ventricle patients regardless of EE (p < 0.05). Significant determinants (modifiable and non-modifiable) of outcome have an independent and cumulative effect on EE failure and the fate of fast track strategy. There was a near three-fold cost increase failing EE/fast track irrespective of case complexity.
Conclusions: Deployment of fast track strategy is justified following CHS during infancy but requires team approach and buy-in by involved caregivers. Patient specific and modifiable parameters can guide judicious use of fast track protocols. Proper customization and implementation can have a powerful impact on cost-containment and care value.
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Acknowledgements
Many thanks to Raquel Esquivel and Emma Geister (Research scholars), Danielle Crethers (Research Coordinator), Departments of Surgery, Anesthesia and Critical Care, and the Chief’s Medical officer collaborators for their contribution and participation.
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Polimenakos, A.C. (2023). Fast Track Approach Following Heart Surgery in Infancy and Early Childhood: Implementation Strategy with Outcome and Cost Analysis. In: Chilingerian, J.A., Shobeiri, S.A., Talamini, M.A. (eds) The New Science of Medicine & Management. Springer, Cham. https://doi.org/10.1007/978-3-031-26510-5_6
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DOI: https://doi.org/10.1007/978-3-031-26510-5_6
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