Original ArticlesFast-Track Cardiac Surgery in a Department of Veterans Affairs Patient Population
Section snippets
Study Design
After Institutional Review Board approval (9/15/95), retrospective data collection was instituted for this project. All patients undergoing cardiac operation at the Denver Veterans Affairs Medical Center requiring cardiopulmonary bypass (CPB) (with the exception of planned circulatory arrest) from January 14, 1992, to October 1, 1995, were entered into a database. Patients were stratified into two consecutive sequential cohorts: pre-FT (January 14, 1992 to September 30, 1993; n = 255) and FT
Results
Patient risk factors are presented in Table 1. The CICSP risk estimate of operative mortality was not statistically different between the pre-FT and FT cohorts (3.5% versus 3.7%; p = 0.13). There were, however, statistically significant differences in several factors used to calculate this estimate (peripheral vascular disease, cardiomegaly, preoperative digoxin use, and preoperative diuretic use). Three variables independently evaluating preexisting lung disease—clinical diagnosis of chronic
Comment
This study reports on FT cardiac surgical management in a Department of Veterans Affairs population. The FT protocol is associated with a reduction in time to extubation along with SICU, intermediate care, and ward LOS. We have documented that patients may be managed with a FT protocol safely, as no major changes in postoperative mortality or morbidity were observed. In addition, our data suggest that this practice may be associated with a reduction in the frequency of nosocomial pneumonia.
Acknowledgements
We acknowledge the dedication and hard work of Sharon Del Hotal, secretary, Anesthesia Section, without whom this study would not have been performed. We also acknowledge the contributions of Elizabeth Munoz with data entry, Donald Huckaby, computer programmer, and Micheal B. Jones, Chief, Information Resources Management Service, for length of stay data extraction; John Hawk, PharmD, for operating room pharmacy records; Judith Wilson, RN, for support from the Nursing Service; Douglas
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