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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2016 Sep 27
Impact of opening hours of the post anaesthetic care unit on fast-track success in cardiac surgery
Christian GRAß 1, Federica STRETTI 2, Waseem ZAKHARY 1, Edwin TURTON 1, Sophia SGOUOROPOULOU 1, Meinhard MENDE 3, Joerg ENDER 1 ✉
1 Department of Anesthesiology and Intensive Care Medicine, Leipzig Heart Centre, Leipzig, Germany; 2 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 3 Department of Coordinating Centre for Clinical Trials, University of Leipzig, Leipzig, Germany
BACKGROUND: Fast track (FT) treatment in cardiac anaesthesia is state of the art. Aim of our study was to compare FT treatment in a post anaesthetic care unit (PACU) with limited opening hours with a PACU opened for unlimited hours. Primary endpoints were extubation time (ET), length of stay (LOS) in PACU and LOS in intermediate care unit (IMC). Secondary endpoints were FT success/failure, hospital LOS, re- intubation and in hospital mortality.
METHODS: At our institution, FT is usually managed in a PACU with limited opening hours from 10am to 10pm, Monday to Friday (PACU12). Due to reconstruction work in 2011, this PACU was open 24 hours per day, Monday to Saturday (PACU24). We retrospectively compared patients admitted to PACU24 during 2011 (January to December) and patients admitted to PACU12 during 2013 (January to December).
RESULTS: 2174 patients were primarily included in the study, 319 had to be excluded. Primary endpoints in PACU12 compared to PACU24 were significantly shorter: median ET (2.0, 95% confidence interval [1.4-2.8] vs. 3.3 [2.2-5.0] hours), median LOS in PACU (4.8 [4.0-5.9] vs. 21.2 [18.3-23.5] hours) and median LOS in IMC (24 [18-64] vs. 38 [22-77] hours). FT success was significantly higher in PACU12 compared to PACU24 (75.3% vs. 39.6%). The in-hospital mortality and re-intubation rate were not significantly different.
CONCLUSIONS: FT treatment in a PACU with limited opening hours leads to more effective treatment for patients regarding extubation time and LOS in IMC than in a PACU with limited opening hours, without compromising safety.