Cheng Davy C H, Wall Claus, Djaiani George, Peragallo Raul A, Carroll Jo, Li Cindy, Naylor David
University of Toronto, Toronto, Ontario, Canada.
Anesthesiology. 2003 Mar;98(3):651-7. doi: 10.1097/00000542-200303000-00013.
The authors assessed the safety and resource use associated with fast-track cardiac anesthesia (FTCA) after coronary artery bypass graft surgery (CABG) over a 1-yr period.
One hundred twenty patients were initially randomized to FTCA (n = 60) or conventional anesthetic (n = 60) for primary elective CABG surgery. Patients were followed for 1-yr after index surgery through linkage to universal administrative databases. Acute care hospital readmission rates and length of stay (LOS) and the downstream use of health resources were compared. Resource use was analyzed as use of hospital and rehabilitation center bed-days, expenditures on physician services, and use of cardiac drugs.
There were no deaths during the 1-yr follow-up after initial discharge; 15 (25%) patients from both groups were readmitted to acute care hospitals in the follow-up period. The mean LOS for acute care readmission was 0.3 (1.0) in the FTCA and 1.6 (6.3) days in the conventional group at 3 months; P= 0.01, 95% CI (0.1, 5.7) and 0.8 (1.8) and 2.9 (9.6) days at 12 months; P= 0.01, 95% CI (0.2, 7.5). Two (3.3%) patients in the FTCA group and 9 (15%) patients in the conventional group were transferred to rehabilitation facilities. The LOS was 0.3 (1.5) and 2.3 (5.7) days respectively; P= 0.001, 95% CI (0.6, 4.0). Specialist visits were more frequent in the FTCA group 6.2 (13.2) versus 1.9 (2.2) visits respectively; P= 0.002, 95% CI (-9.0, -1.3). Percentage reduction of FTCA cost was 68% at 3 months, P= 0.0002 and 49.5% at 1-yr, P= 0.004 after index hospital discharge.
Fast-track cardiac anesthesia is a safe practice that decreases resource use for a 1-yr period after index hospitalization.
作者评估了冠状动脉搭桥手术（CABG）后快速心脏麻醉（FTCA）在1年期间的安全性和资源使用情况。
120例患者最初被随机分为FTCA组（n = 60）或传统麻醉组（n = 60），接受初次择期CABG手术。通过与通用行政数据库链接，对患者在索引手术后进行1年的随访。比较急性护理医院再入院率、住院时间（LOS）以及下游卫生资源的使用情况。资源使用情况分析包括医院和康复中心病床日的使用、医生服务支出以及心脏药物的使用。
初次出院后的1年随访期间无死亡病例；两组各有15例（25%）患者在随访期间再次入住急性护理医院。3个月时，FTCA组急性护理再入院的平均住院时间为0.3（1.0）天，传统组为1.6（6.3）天；P = 0.01，95%CI（0.1，5.7）；12个月时分别为0.8（1.8）天和2.9（9.6）天；P = 0.01，95%CI（0.2，7.5）。FTCA组有2例（3.3%）患者和传统组有9例（15%）患者被转至康复机构。住院时间分别为0.3（1.5）天和2.3（5.7）天；P = 0.001，95%CI（0.6，4.0）。FTCA组专科就诊更频繁，分别为6.2（13.2）次和1.9（2.2）次；P =
