London M J, Shroyer A L, Jernigan V, Fullerton D A, Wilcox D, Baltz J, Brown J M, MaWhinney S, Hammermeister K E, Grover F L
Department of Anesthesiology, University of Colorado Health Sciences Center, Denver Veterans Affairs Medical Center, USA.
Ann Thorac Surg. 1997 Jul;64(1):134-41. doi: 10.1016/s0003-4975(97)00248-8.
"Fast-track" (FT) cardiac surgery is popular in the private and university sectors. This study was designed to examine its safety and efficacy in the Department of Veterans Affairs elderly, male patient population, a population with multiple comorbid risk factors, often decreased social functioning, and impaired support systems.
Time to extubation, hospital length of stay, perioperative morbidity, and mortality were studied in two consecutive cohorts undergoing cardiac operations requiring cardiopulmonary bypass before (pre-FT: n = 255, January 1992 to September 1993) and after (FT: n = 304, October 1993 to October 1995) institution of an FT protocol at a university-affiliated teaching Department of Veterans Affairs medical center. Preoperative risk factors, including a Department of Veterans Affairs risk-adjusted estimate of operative mortality, and perioperative surgical and anesthetic processes of care were evaluated.
The mean Department of Veterans Affairs risk estimate of perioperative mortality was not different between the pre-FT and FT cohorts (3.5% versus 3.7%, p = 0.13). In the FT cohort, median time to extubation decreased significantly (19.2 versus 10.2 hours; p < 0.001) along with median surgical intensive care unit stay (96 versus 49 hours; p < 0.001) and total postoperative length of stay (222 versus 167 hours; p < 0.001). Median postoperative day of hospital discharge decreased from day 10 to 7 (p < 0.001). One patient (0.3%) required emergent reintubation directly related to early extubation. Reintubation for medical reasons was unchanged between pre-FT and FT groups (6.3% versus 5.0%; p = 0.48). Postoperative morbidity was similar between groups except for nosocomial pneumonia, the rate of which decreased significantly in the FT cohort (14.7% versus 7.3%; p < 0.005). Thirty-day (3.9% versus 4.6%; p = 0.69) and 6-month mortality (6.7% versus 6.9%; p = 0.91) were unchanged.
An FT cardiac surgery protocol has been instituted in a university-affiliated teaching Department of Veterans Affairs medical center, with decreased length of stay and no significant increase in postoperative morbidity, 30-day mortality, or 6-month mortality. It was associated with a lower rate of nosocomial pneumonia, a finding that must be validated in a prospective study.
“快速通道”（FT）心脏手术在私立医院和大学医院中很常见。本研究旨在探讨其在退伍军人事务部老年男性患者群体中的安全性和有效性，该群体存在多种合并症风险因素，社会功能常减退，支持系统受损。
在一所大学附属的退伍军人事务部教学医疗中心，对实施FT方案前后连续两个队列中接受需要体外循环的心脏手术的患者进行研究，比较拔管时间、住院时间、围手术期发病率和死亡率。术前评估风险因素，包括退伍军人事务部手术死亡率的风险调整估计值，以及围手术期手术和麻醉护理过程。
FT组和FT前组围手术期死亡率的退伍军人事务部平均风险估计值无差异（3.5%对3.7%，p = 0.13）。在FT组中，拔管中位时间显著缩短（19.2小时对10.2小时；p < 0.001），手术重症监护病房住院中位时间（96小时对49小时；p < 0.001）和术后总住院时间（222小时对167小时；p < 0.001）也显著缩短。术后出院中位天数从第10天降至第7天（p < 0.001）。1例患者（0.3%）因早期拔管直接需要紧急重新插管。FT组和FT前组因医疗原因重新插管的情况无变化（6.3%对5.0%；p = 0.48）。除医院获得性肺炎外，两组术后发病率相似，FT组医院获得性肺炎发生率显著降低（14.7%对7.3%；p < 0.005）。30天死亡率（3.9%对4.6%；p = 0.69）和6个月死亡率（6.7%对6.9%；p = 0.91）无变化。
一所大学附属的退伍军人事务部教学医疗中心已实施FT心脏手术方案，住院时间缩短，术后发病率、30天死亡率或6个月死亡率无显著增加。它与较低的医院获得性肺炎发生率相关，这一发现必须在前瞻性研究中得到验证。
