Korean J Thorac Cardiovasc Surg 2018; 51(4): 247-253  https://doi.org/10.5090/kjtcs.2018.51.4.247
Early Experiences with Ultra-Fast-Track Extubation after Surgery for Congenital Heart Disease at a Single Center
Kang Min Kim, M.D.1, Jae Gun Kwak, M.D., Ph.D.1, Beatrice Chia-Hui Shin, M.D.1, Eung Re Kim, M.D.1, Ji-Hyun Lee, M.D., Ph.D.2, Eun Hee Kim, M.D.2, Jin Tae Kim, M.D., Ph.D.2, Woong-Han Kim, M.D., Ph.D.1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, 2Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
Corresponding author: Jae Gun Kwak, Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital,Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
(Tel) 82-2-2072-3638 (Fax) 82-2-764-3664 (E-mail) switch.surgeon@gmail.com
Received: October 30, 2017; Revised: November 15, 2017; Accepted: November 16, 2017.; Published online: August 5, 2018.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

cc This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Early extubation after cardiovascular surgery has some clinical advantages, including reduced hospitalization costs. Herein, we review the results of ultra-fast-track (UFT) extubation, which refers to extubation performed on the operating table just after the operation, or within 1–2 hours after surgery, in patients with congenital cardiac disease.
Methods: We performed UFT extubation in patients (n=72) with a relatively simple congenital cardiac defect or who underwent a simple operation starting in September 2016. To evaluate the feasibility and effectiveness of our recently introduced UFT extubation strategy, we retro-spectively reviewed 195 patients who underwent similar operations for similar diseases from September 2015 to September 2017, including the 1-year periods immediately before and after the introduction of the UFT extubation protocol. Propensity scores were used to assess the effects of UFT extubation on length of stay (LOS) in the intensive care unit (ICU), hospital LOS, and medical costs.
Results: After propensity-score matching using logistic regression analysis, 47 patients were matched in each group. The mean ICU LOS (16.3±28.6 [UFT] vs. 28.0±16.8 [non-UFT] hours, p=0.018) was significantly shorter in the UFT group. The total medical costs (182.6±3.5 [UFT] vs. 187.1±55.6 [non-UFT] ×100,000 Korean won [KRW], p=0.639) and hospital stay expenses (48.3±13.6 [UFT] vs. 54.8±29.0 [non-UFT] ×100,000 KRW, p=0.164) did not significantly differ between the groups.
Conclusion: UFT extubation decreased the ICU LOS and mechanical ventilation time, but was not associated with postoperative hospital LOS or medical expenses in patients with simple congenital cardiac disease.
Keywords: Congenital heart disease, Ultra-fast track, Early extubation, Medical expenses, Intensive care unit length of stay


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