Ultrafast Track Pathway After Low-Risk Cardiac Surgery Enables Intensive Care Unit Stepdown Within 6 Hours: A Feasible Model for Anesthesia-Led Recovery.

OBJECTIVE

The aim of this study was to assess the feasibility and safety of the ultrafast track (UFT) integrated care pathway in cardiac surgery patients defined as intensive care unit (ICU) discharge within 6 hours.

DESIGN

A prospective cohort study.

SETTING

University Medical Center, the Netherlands.

PARTICIPANTS

A total of 261 adults (median age 70 [62-75], 72.4% male) with EuroSCORE II <3% and additional criteria undergoing elective or urgent coronary artery bypass graft, aortic valve replacement, or mitral valve repair.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

UFT completion was achieved in 209 patients (80.1%). 159 (60.9%) patients were extubated in the operating room after surgery. There were 13 reintubations, 12 for the need of a reoperation, and one due to respiratory insufficiency. No patients died within 30 days, and 97% of the cohort was still alive at follow-up. Successful patients had lower postoperative troponin, creatinine, pleural/mediastinal/pericardial drain output, fewer reoperations (1.5% v 19.2%) and a shorter hospital length of stay (5 days v 6 days).

CONCLUSION

The UFT protocol including stepdown from ICU within 6 hours after surgery proved feasible and safe to implement in a carefully selected cardiac surgery population and enabled efficient ICU bed turnover without compromising clinical outcomes. This approach may support the broader implementation of fast-track strategies.