Rapid Recovery Program in Cardiovascular Surgery under Cardiopulmonary Bypass

pp 163-174

Abstract

Objective

The aim of the present study was to develop a rapid recovery program in our institution and to observe its implications on patients outcome and costs.

Method

Between May and September 1995 we performed 326 consecutive cardiac surgery operations, under cardiopulmonary bypass. The patients included in this protocol were 152, with median age of 59.2 ±14 (23 to 83),123 (80.9%) were men and 29 (19.1%) were woman. The left ventricular function was good or mild in 93 patients (61.2%), moderate in 47 (31%) and severe in 12(7.8%). Comorbidity: hypertension in 97 patients (63,8%), diabetes 24 (15.7%), previous acute myocardial infarct 49 (32%). Surgery was elective in 100% c ses. We performed CABG on 103 patients (67.7%), valvular surgery on 35 (23.2%), congenital surgery on 2 (1.3%) and CABG plus valvular surgery on 12(7.8%).The inclusion criteria were: hemodynamic stability, MAP > 75, RAP < 12, LAP < 15, cardiac rate < 120; diuresis > 1 ml/kg, saturation > 95 on IFO2<_50, repiratory rate < 25, mechanical ventilation < 18 hours, bleeding < 100cc in the last 5 hours and no ventricular arrhythmias. The mean cardiopulmonary bypass time was 81.7 ±28 minutes and mean aortic cross clamp time was 50.3 ± 17.3 minutes.

Results

The program was possible in 152 patients (46.6%).The mean extubation time was 6.98 ±2.9 hours and the mean length of stay in cardiac surgery intensive care unit was 20.1 ± 7.33 hours. The complications in cardiac surgery intensive care unit included: atrial fibrillation 45 patients (29%), perioperative ischemia 12 (7.8%) and hyperglycemia 68(44.7%). The patients had some of the following complications in the general care area: acute fibrillation 14 patients (9.2%), cerebrovascular accident 2 (1.3%), acute renal failure and oliguria 13 (8.5%), respiratory insufficiency 9 (5.5%), infection disease 8 (5.2%), hyperglycemia 2 (1.3%), lack of trust in the program 13(8.5%). Readmission to intensive care unit ocurred in 8 patients (5.2%) and the causes were: 3 acute failure, 2 acute renal failure, 1 pneumothorax, 1 mediastinitis and 1 respiratory infectious disease, sepsis and finally death. The overall mortality rate of the program was 0.6% (1 patient).The mean duration of postoperative hospital stay was 6.17 ± 2.75 days; 95 patients (62.5%) were discharged by the 5th postoperative day, 22 between 5th and 7th day (21.7%), 17 between 8th and 11th day (11.2%) and finally 7 between 12nd and 23rd day(4.8%).We had 3.2% (5 patients) of rehospitalization in the first 30 days of follow up and no re-admissions were registered between 60 and 90 days of follow up. There were no deaths in the readmission group.ConclusionThis study proved that it was possible to carry outa rapid recovery program at our institution. The very low mortality rate (0.6%) and only 3.2% of readmission during 30 day of follow up and no further re hospitalization during 60 to 90 days of follow up demonstrated a very favourable outcome in this group of patients. This program resulted insubstantial cost savings.