Does Ultra-fast-track Therapy Post Robotic-assisted Cardiac Surgery Increase Incidence Of Medical Complications At 30 Days ?
Hussein Al-Amodi1, Feras Khaliel1, Vincenzo Giambruno1, Joel Bierer2, Michael W.A Chu1, Christopher Harle1, Ivan Iglesias1, Kumar Sridhar1, Patrick Teefy1, Rodrigo Bagur1, Shahar Lavi1, Bob Kiaii1.
1London Health Sciences Centre, Western University, London, ON, Canada, 2Schulich school of medicine and dentistry, Western University, London, ON, Canada.
An Ultra-fast-track approach to cardiac surgery has previously been described as an effective means to bypass the cardiac surgical intensive care unit (CSICU) in selected patients undergoing robotic-assisted minimally invasive coronary artery bypass surgery (RA-CABG). However, precise selection criteria for this cohort of patients are not properly defined. The goal of this study was to review 30 day follow-up of patients following an ultra-fast-track approach in order to identify optimal selection criteria for applying the ultra-fast track approach.
We retrospectively reviewed our cardiac surgery database between 2006 and 2016. We identified 90 adult patients who had undergone RA-CABG, and 6 patients in whom RA-CABG was attempted but who required conversion to sternotomy. Patients were selected for ultra-fast-track care by a multidisciplinary team and post-operative follow-up ocurred either in an outpatient clinic or via telephone. We determined whether patients sought medical attention during the first 30 days postoperatively, or were readmitted to hospital, and the reason for seeking care.
The average patient age was 61.2 ± 9.4 years, 78.1% were male, and 21.9% were female. Outpatient clinic follow-up was conducted in 97.9% of patients, and 2.1 % had a phone call, as we were unable to arrange in-person follow-up. In total, 7.2% of patients required readmission to hospital mainly due to underlying lung disease, and 3.1% sought medical attention within the first 30 post-operative days for superficial wound infection, shortness of breath due to atelectasis and non specific back pain. There was no post-operative mortality within 30 days.
The ultra-fast track approach to postoperative care following RA-CABG in carefully selected patients can reduce hospital length of stay and potentially post-operative complications due to prolonged CSICU stay. In this cohort, patients who
underwent an ultra-fast track protocol after RA-CABG had a low incidence of complications including readmission to hospital in 30 days. In most of the cases, this was due primarily to underlying Chronic Obstructive Pulmonary Disease (COPD). We therefore suggest that further investigation is warranted among patients with COPD to identify strict criteria to determine eligibility for an ultra-fast track approach following RA-CABG.
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