Is Faster Always Better? Ultra-Fast-Track Versus Fast-Track Extubation in Adult Cardiac Surgery: A Comprehensive Meta-analysis With Meta-regression.

OBJECTIVES

To compare the clinical outcomes of ultra-fast-track extubation (UFTE), defined as extubation in the operating room or within 1 hour postoperatively, versus fast-track extubation (FTE), defined as extubation within 6 hours in the intensive care unit [ICU]), in adult patients undergoing cardiac surgery.

DESIGN

Systematic review and meta-analysis.

SETTING

Studies identified from MEDLINE, Scopus, and the Cochrane Library.

PARTICIPANTS

Adult patients undergoing cardiac surgery.

INTERVENTIONS: Comparison of UFTE versus FTE.

MEASUREMENTS AND MAIN

RESULTS

Twenty studies including nearly 800,000 patients were analyzed. UFTE was associated with lower 30-day mortality (odds ratio [OR], 0.54), shorter ICU length of stay (LOS) (mean difference [MD], -12.27 hours), shorter hospital LOS (MD, -1.19 days), reduced stroke rate (OR, 0.85) and reduced readmission rate (OR, 0.64). Rates of reintubation, reoperation for bleeding, acute kidney injury, pneumonia, and atrial fibrillation were similar. In the minimally invasive cardiac surgery subgroup, UFTE was associated with lower reintubation risk (OR, 0.26), whereas in the coronary artery bypass grafting subgroup, only hospital LOS was reduced. In propensity-matched cohorts, mortality and reintubation were comparable, although ICU and hospital stays remained shorter with UFTE. Meta-regression identified male sex and baseline left ventricular ejection fraction as significant moderators of the mortality effect.

CONCLUSIONS

UFTE appears safe in selected patients and is associated with improved efficiency and recovery, particularly reduced ICU and hospital LOS. However, the observed mortality benefit is not sustained after adjustment, suggesting an important role of patient selection and perioperative optimization. Prospective randomized trials are required to confirm these findings.