Assessing the safety, feasibility, and clinical outcomes of a fast-track strategy in open cardiac surgery.

Objectives: To study feasibility, safety and clinical outcomes after the implementation of a fast-track concept after open cardiac surgery.

Methods: A single-center observational study (2018-2023) using data from the cardiothoracic intensive care unit (ICU) registry at the Karolinska University Hospital and the SWEDEHEART registry. The fast-track intervention included immediate extubation, early and frequent mobilization, prompt oral intake and transfer to regular ward the day after surgery. Main outcomes were proportion of patients discharged to regular ward on the first postoperative day, length of hospital stay, and 30-day mortality.

Results: 5234 open cardiac procedures were performed of which 2801 patients (78% men, median age 63 years SD 12.3, mean EuroSCORE II 2.0 SD 2.0) were treated at the fast-track unit. The most common procedures were coronary artery bypass grafting (CABG, 42.4%) and single non-CABG procedure (37.5%). In total, 94.6% (n = 2649) of patients were discharged the day after surgery. Of those requiring ICU care (n = 152), circulatory failure (n = 57) and reoperation due to bleeding or tamponade (n = 51) were most frequent. Patients with fast-track failure had a EuroSCORE II of 2.9 vs 1.9 in discharged patients (p < 0.001). Median hospital stay was 5 days for patients discharged as planned, compared to 8.7 days for those transferred to ICU (p < 0.001). The 30-day mortality was 0.3%, with 0.2% in patients discharged as planned and 1.3% in those requiring ICU transfer (p = 0.096).

Conclusions: Following the fast-track implementation after open cardiac surgery, approximately 95% of patients were discharged the day after surgery, with a 30-day mortality rate of 0.3%.