Early Discharge With Fast‐Track Protocol After Median Full Sternotomy in Cardiac Surgery
Takuya Ogami, Liliya Pospishil, Jamie M. Eridon, Peter J. Neuburger, Samantha Lo, Lucille Lannan, Liora Rafailova, Mathew R. WilliamsABSTRACT
Background
Fast‐track (FT) protocol is an established but not standardized approach in cardiac surgery. We aimed to describe our FT protocol and to compare outcomes before and after the protocol implementation (non‐FT group and FT group, respectively).
Methods
Fast‐track protocol was implemented in March 2021 in our institution. All patients who underwent median sternotomy from January 2018 to June 2024 were identified. Patient characteristics and outcomes were compared between the FT group and non‐FT group, using propensity‐score matching.
Results
A total of 456 patients, primarily aortic valve replacement, mitral valve repair or replacement, and root and ascending aortic surgery, were included. Of 456, 261 patients were the FT group and 195 patients were the non‐FT group. In the FT group, 91.6% of patients were extubated in the OR (vs. 42.1% in the non‐FT group, p < 0.001). In the FT group, 193 (73.9%) were discharged within 2 or 3 days after surgery. After propensity‐score matching, the median hospital length of stays (LOS) was significantly shorter in the FT group (3 days vs. 4 days, p < 0.001). Baseline characteristics, operations, and perioperative outcomes were similar between the groups, including 30‐day mortality (0.5% vs. 0.5%, p = 1.0), prolonged ventilation (1.1% vs. 1.1%, p = 1.0), discharge to home (1.6% vs. 2.2%, p = 0.72), and readmission (3.8% vs. 4.3%, p = 0.80).
Conclusions
The FT protocol was associated with decreased hospital LOS. Additionally, this study suggested that discharge within 3 postoperative days is feasible after most valve surgeries.