Retrospective analysis of pre- and intraoperative risk factors for readmission to the intensive care unit after fast track cardiac surgery

Objectives: The introduction of fast-track treatment procedures following cardiac surgery has significantly shortened hospitalisation times in intensive care units (ICU). Readmission to intensive care units is generally considered a negative quality criterion. The aim of this retrospective study is to statistically analyse risk factors and predictors for re-admission after a fast-track patient management program.

Methods: 229 operated patients (67 ± 11 ys, 75% male, BMI 27 ± 3, 6/2010 – 5/2011) with use of extracorporeal circulation (70 ± 31 min aortic crossclamping, CABG 62%) were selected for a preoperative fast-track procedure (transfer on the day of surgery to an intermediate care (IMC) unit, stable circulatory conditions, extubated). 58 items were recorded and analysed.

Results: Over the 11-month study period, 36% of all preoperatively declared fast-track patients could not be transferred to an IMC unit on the day of surgery or had to be readmitted to the ICU after the first postoperative day usually because of bleeding- (22%), pulmonary- (14%) or renal (11%) problems. Readmission signifies a dramatic worsening of the patient outcome (mortality 0/10%, hospital stay 10.3 ± 2.5/16.5 ± 16.3, transfusion rate 1.4 ± 1.7/5.3 ± 9.1). Predicators for failure of the fast-track procedure are a preoperative ASA> 3, NYHA>III and an operation time > 267 min ± 74. The significant risk factors for a major postoperative event are a poor EF (OR 2.7 CI 95% 0.98 – 7.6) and the described ICU readmission (OR 0.14 CI95% 0.05 – 0.36).

Conclusions: The failure of a fast-track patient management concept is associated with a high loss of patient outcome. Major pre-operative selection factors of suitable fast-track patients are the ASA- and NYHA classes as well as intraoperatively recorded operation time.