A clinical and economic evaluation of fast-track recovery after cardiac surgery.
ABSTRACT In the last 5 decades, the care of cardiac surgical patients has improved with the aid of strategies aimed at facilitating patient recovery. One of the innovations in this context is "fast-tracking" or "rapid recovery." This process refers to all interventions that aim to shorten a patient's stay in the intensive care unit (ICU) through accelerating the patient's transfer to a step-down or telemetry unit and to the general ward.
Patients were allocated to 2 groups. The fast-track group (n = 84) went through an independent theatre recovery unit (TRU). The patients were then transferred on the same day to an intermediate care unit and transferred on the following day to the ward. The intensive care group (52 patients) went to the ICU for at least 1 day, after which they were transferred to the ward.
The fast-track pathway significantly reduced the length of stay (LOS) in an intensive care facility (P < .001). The duration of intubation was reduced from a median of 4.08 hours (range, 1.17-13.17 hours) in the intensive care group to 2.75 hours (range, 0.25-18.57 hours) in the fast-track group (P < .001). However, the median values for total hospital LOS, incidences of complications, reintubation, and readmission were similar for the 2 groups. The incidence of failure in the fast-track group was 10%. The mean (SD) cost of the perioperative care was £4182 ± £2284 ($6683 ± 3650) for the fast-track patients, compared with £4553 ± £1355 ($7277 ± $2165) for the intensive care group.
Fast-track recovery after cardiac surgery decreases the intensive care LOS and the total duration of intubation. It is a cost-effective strategy compared with conventional recovery protocols; however, it does not reduce the total hospital LOS or the incidence of complications.
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ABSTRACT: To define the different types of costs incurred in the care of critically ill patients and to describe some of the most commonly used methods for measuring and allocating these costs. Literature review. Definitions for opportunity, direct and indirect, fixed, variable, marginal, and total costs are described and interpreted in the context of the critical care setting. Two main methods of costing are described: the 'top-down' and 'bottom-up' methods together with a number of cost proxies, such as the use of weighted hospital days, diagnosis-related groups, severity and activity scores, and effective costs per survivor. The assessment and allocation of costs to critically ill patients is complex and as a result of the different definitions and methods used, meaningful comparisons between studies are plagued with difficulty. When undertaking a study looking to measure costs, it is important to state: (a) the aim of the cost assessment study; (b) the perspective (point of view); (c) the type of costs that need to be measured; and (d) the time span of assessment. By being explicit about the rationale of the study and the methods used, it is hoped that the results of economic evaluations will be better understood, and hence implemented within the critical care setting.Intensive Care Medicine 07/2002; 28(6):680-5. · 5.26 Impact Factor
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ABSTRACT: The recurrent or new trends of early extubation after cardiac surgery are here to stay in the 1990s. The preoperative status does not necessarily predict the postoperative course and prolonged mechanical ventilation following cardiac surgery should not be uncritically considered as routine. All patients should be assessed for tracheal extubation at the earliest opportunity when the criteria are met in the ICU. Early extubation post-cardiac surgery does reduce ICU and hospital length of stay and costs. It also allows early ICU discharge and reduces case cancellations without any increase in postoperative complications and readmission. These studies have emphasized that the change in the process of care to early extubation can affect patient outcome as well as costs in cardiac patient care. The substantial difference in cost savings per cardiac case between "criteria discharge" and "actual discharge" points out the importance of the organization of the process of care being delivered. To achieve maximum cost benefit from early extubation in cardiac patients, the organization of the perioperative management of these patients must be optimized. This process of care includes intraoperative anesthetic modification; organization of ICU and staff expertise; postoperative early extubation and management; acute pain service; ICU discharge policy; utilization of step-down unit and surgical ward; and communication among cardiac patient management teams (cardiovascular surgeon, cardiac anesthesiologist, ICU staff, nurses, respiratory therapists, physiotherapists, and social workers), which are all vital to the success of such a program.Journal of Cardiothoracic and Vascular Anesthesia 09/1995; 9(4):460-4. · 1.45 Impact Factor
- Heart (British Cardiac Society) 12/2004; 90(11):1344-5. · 5.01 Impact Factor