Accelerated Recovery after Cardiac Operations

Abstract

Background: The accelerated-recovery approach, involv-ing early extubation, early mobility, decreased duration of intensive care unit stay, and decreased duration of hospitaliza-tion has recently become a controversial issue in cardiac surgery.
Methods: We investigated timing of extubation, length of intensive care unit stay, and duration of hospitaliza-tion in 225 consecutive cardiac surgery patients. Of the 225 patients, 139 were male and 86 were female; average age was 49.73 ± 16.95 years. Coronary artery bypass grafting was performed in 127 patients; 65 patients underwent aortic and/or mitral or pulmonary valvular operations; 5 patients underwent valvular plus coronary artery operations; and in 28 patients surgical interventions for congenital anomalies were carried out.
Results: The accelerated-recovery approach could be applied in 169 of the 225 cases (75.11%). Accelerated-recovery patients were extubated after an average of 3.97 ± 1.59 hours, and the average duration of stay in the intensive care unit was 20.93 ± 2.44 hours for these patients. Patients were dis-charged if they met all of the following criteria: hemody-namic stability, cooperativeness, ability to initiate walking exercises within wards, lack of pathology in laboratory inves-tigations, and psychological readiness for discharge. Mean duration of hospitalization for accelerated-recovery patients was 4.24 ± 0.75 days. Two patients (1.18%) who were extu-bated within the first 6 hours required reintubation. Four patients (2.36%) who were sent to the wards returned to intensive care unit due to various reasons and 6 (3.55%) of the discharged patients were rehospitalized.
Conclusions: Approaches for decreasing duration of intu-bation, intensive care unit stay and hospitalization may be applied in elective and uncomplicated cardiac surgical inter-ventions with short duration of aortic cross-clamping and cardiopulmonary bypass, without risking patients. Frequen-cies of reintubation, return to intensive care unit, and rehos-pitalization are quite low with this approach.