%0 Journal Article
%T Fast Track Extubation Post Coronary Artery Bypass Graft: A Retrospective Review of Predictors of Clinical Outcomes*
%A Shelly Bansal
%A H. M. Thai
%A C. H. Hsu
%A C. B. Sai-Sudhakar
%A S. Goldman
%A B. E. Rhenman
%J World Journal of Cardiovascular Surgery
%P 81-86
%@ 2164-3210
%D 2013
%I Scientific Research Publishing
%R 10.4236/wjcs.2013.32014
%X <b><span>Introduction:</span></b><span> Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-op</span><span>erative progression to discharge, and have been practiced for more than two decades. Their goal is to optimize patient care perioperatively in order to decrease costs without negatively affecting morbidity and mortality. However, the fac</span><span>tors that predict successful EE are poorly understood, and patients with significant co-morbidities are frequently ex</span><span>cluded from protocols. We hypothesize that independent of disease severity, early extubation leads to shorter hospital stays and can be performed safely without negatively affecting outcomes. <b>Materials and Methods:</b> We performed a retrospective review of 919 patients who underwent coronary artery bypass grafting (CABG) at the Southern Arizona Veteran¡¯s Affairs Health Care System medical center over 7 years. We collected pre-operative data regarding patients¡¯ NYHA classification, presence and severity of cerebral vascular disease, peripheral vascular disease, pulmonary disease, diabetes and hypertension. Intra-operative variables were also recorded including ASA scores, ischemic times, and time to extubation. Finally, post-operative variables such as rates of reintubation and tracheotomy, and both length of ICU and total hospital stay were also compared. <b>Results:</b> Prolonged periods of ischemia were found to predict a delayed extubation (HR</span><span> </span><span>= 0.992; CI = 0.988</span><span> </span><span>-</span><span> </span><span>0.997, p = 0.0015) while small body surface area (HR</span><span> </span><span>=</span><span> </span><span>1.57; CI</span><span> </span><span>=</span><span> </span><span>1.13, 2.17, p = 0.007) and higher pre-operative functional status of the patient, such as independent versus dependent status (HR</span><span> </span><span>=1.68; CI</span><span> </span><span>=</span><span> </span><span>1.30</span><span> </span><span>-</span><span> </span><span>2.16, p &lt; 0.0001), or partially dependent to fully dependent status (HR</span><span> </span><span>=</span><span> </span><span>1.33; CI</span><span> </span><span>=</span><span> </span><span>1.03</span><span> </span><span>-</span><span> </span><span>1.70, p = 0.03) were found to be associated with earlier extubation. The early extubation (EE) group (those extubated in less than the median 7.3 hours) had an average hospital stay of 5.1 ¡À 4.0 days, versus 7.8 ¡À 8.1 days in the delayed group (&gt;4 hours), p &lt; 0.0001. The EE group also
%K Coronary Artery Bypass
%K Fast Track
%K Early Extubation
%K Postoperative Period
%K Intensive Care
%K Intubation
%K Treatment Outcome
%K Airway Extubation
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=33399