Clinical Outcomes of a Goal-Directed Ultra-Fast-Track Anesthesia Pathway Targeting Operating Room Extubation in Cardiac Surgery: A Propensity Score-Matched Cohort Analysis.

OBJECTIVE

To compare the safety and outcomes of ultra-fast-track anesthesia (UFTA) extubation versus conventional anesthesia with intensive care unit (ICU) extubation in cardiac surgery under cardiopulmonary bypass (CPB).

DESIGN

Retrospective, propensity score-matched cohort study.

SETTING

Single academic tertiary referral hospital.

PARTICIPANTS

Four hundred adult patients undergoing elective open cardiac surgery requiring CPB between March 2018 and July 2019 were retrospectively analyzed.

INTERVENTIONS: UFTA was defined as a goal-directed strategy targeting operating room extubation (UFTA/IE) with short-acting, low-dose opioid anesthesia, compared to conventional ICU extubation with higher-dose opioids. After 1:2 propensity score matching, 51 patients in the UFTA/IE group and 99 patients in the conventional ICU extubation group were included. The primary outcome was the incidence of overall postoperative complications.

MEASUREMENTS AND MAIN

RESULTS

Overall postoperative complications were similar between groups (54.9% v 56.6%, p = 0.846). The matched logistic regression revealed no significant associations (odds ratio: 0.935, 95% CI 0.475 to 1.853). UFTA markedly shortened extubation time (mean difference [MD]: -747.2 minutes, 95% CI -915.0 to -579.4, p < 0.001) without increasing reintubation. Day 0 hemodynamic support (mean vasoactive-inotropic score: MD -1.4, 95% CI -2.2 to -0.5; maximum vasoactive-inotropic score: MD -3.9, 95% CI -5.4 to -2.3; both p < 0.001) and fluid intake (day 0: MD -309.0 mL, 95% CI -543.0 to -75.1, p = 0.010; day 1: MD -211.9 mL, 95% CI -385.9 to -37.9, p = 0.017) were lower in the UFTA/IE group.

CONCLUSION

In selected adults undergoing elective CPB cardiac surgery, the UFTA pathway was not associated with increased postoperative complications and may improve early postoperative recovery.