CABG-procedures in patients with advanced age: Early extubation and fast track management as an option?

Objective: In cardiac surgery shorter hospital stays and decreased costs can be reached by early extubation and fast-track management protocols. The feasibility of such protocols in elderly patients is still discussed controversially.

Methods: We analyzed 800 consecutive patients undergoing CABG. 496 patients (62%) underwent early extubation, defined as extubation within 6 hours postoperatively (group e). In the early extubated group elderly patients of at least 75 years (n=210) were compared with younger patients (n=286, 61.2 years).

Results: The mean length of stay (LOS) in hospital in group e was 8.9 vs. 13.4 days for patients who underwent later extubation (p<0.01). The hospital mortality rate was comparable between the older and the younger group of patients (2.4% vs. 2.1%). Reintubation rate was negligible in both groups of patients. Older patients had a significantly higher incidence of postoperative atrial fibrillation (30% vs. 22.5%). We found a shorter LOS in hospital among the younger patients (8.6±1.2 vs. 10.1±1.3 days, p<0.05), although the LOS on ICU was similar (old: 30±5 vs. 27±4 hours, p>0.05). In group e we could differ between immediate extubation (before ICU) and extubation in the following 6 hours. The immediate extubation could be correlated to the most uncomplicated postoperative courses among all early extubated patients.

Conclusion: The results confirm the possibility of early extubation among elderly patients undergoing CABG procedures, in selected cases even in the operation theatre. Although they have more comorbid conditions, an early extubation may result in a shortened LOS in hospital.