Is Fast Track Cardiac Anaesthesia Cost Effective without Compromising Morbidity and Mortality?

Abstract

Background: With the evolution of anaesthesia and surgical procedures, fast track cardiac anaesthesia (FTCA) has gained an increased  interest, mainly based on the possibility of reducing health costs without compromising patient care and wellbeingObjective:The purpose of this study was to evaluate different durations in Early Extubation (EE) like Aortic Cross Clamp Time (ACCT),Cardiopulmonary bypass time (CPB Time), Mechanical Ventilation Duration (MVD), Operation Room time (ORT), Intensive Care Unit (ICU) and post ICU time as well as Total Hospital Stay Time (THST) in open heart procedures. This has been done to co-relate FTCA with lowering of hospital expenditure without compromising with morbidity and mortality.
Methods: This is a “Prospective Cohort Study” comprising of a group of 80 patients who underwent open heart surgery in a Rural Cardiac Center, in 2014. After FTCA and surgical technique, we reviewed the duration of mechanical ventilation, length of Intensive Care Unit stay, reintubation, and incidence of in-hospital mortality and followed our cases prospectively till discharge from the hospital.
Results : The group of Fast Track Cardiac Anaesthesia comprised of 80 patients. Range of ventilation duration (VD ) was 2-4 hours in 12.8%) to 8-10 hours in 9% cases; Aortic cross clamp time (ACCT) in minutes was 25-49 in 35% cases to 100-124 in 2.7% of cases. Similarly Range of Cardio- pulmonary Bypass Time (CPBT) in minutes 40-69 minutes in 21.6% to 160-190 minutes in 4% cases, surgery time (ST) in hours was 2-3 in 7.5% cases to 6-8 in 28.8 % cases; operation room time (ORT) in hours was 2-4 in 3.8% to 6-8 hours in 28.8% patients; ionotropic duration (ID) in hours was 2-5 in 20% to 18 to 24 hours in 6.3% cases; Intensive Care Unit (ICU) stay in days was 1-2 days in 66.3% to 3-4 days in 3.8% cases ;and post ICU stay in days was 2-3 in 1.3% to 6-7 in 87.5% patients.Total hospital stay in days was 4-6 days in 4 case, 7-9 in 40 cases and 10-12 days in 36 cases.Reintubation was done only in 1 out of 78 cases. In our study there was no mortality. Conclusions :Fast track Cardiac anaesthesia is suitable with applied anesthetic technique in our centre. However there exists relatively small risk of re-intubation (1.3%). Small sample size is pointer towards a little lack of statistical strength of the study. JMS 2017; 20(1):22-30