Background Fast-track extubation is a key component of the interdisciplinary treatment concept Enhanced Recovery After Surgery (ERAS). In preparation for implementing ERAS as a comprehensive approach, we aimed to analyze the current state of fast-track extubation in the operating room, focusing on Minimally Invasive Cardiac Surgery (MICS). Specifically, we assessed the potential benefits of immediate on-table extubation compared to extubation within six hours after the completion of MICS. Methods During a 4-year period from 2019–2023, a total of n = 146 patients underwent MICS at our institution. Surgical aspects were retrospectively analysed along with patients' risk profiles and relevant comorbidities. After 1:1 best neighbor propensity score matching, patients who were admitted to intensive care unit intubated but were extubated within six hours after surgery (fast-track, FT) were compared to those who were extubated in the operating room (extubation in tabula, EIT). The primary endpoint was fast-track failure (FTF), a composite of setbacks in the postoperative course: revision surgery, re-intubation, and readmission to ICU or intermediate care unit (IMC). Results Patients had a median age of 61 years (IQR: 51.3–67.8) and were predominantly male (76.7%). The primary study endpoint occurred in 20.0% of all matched patients (FT: 26.7%, EIT: 13.3%; p = 0.289). FT patients had longer cardiopulmonary bypass times FT 165.0 min (146.5–217.5); EIT 158.5 min (128.0–189.5); p = 0.047, but the duration of surgery was comparable. Additionally, the average length of hospital stay did not differ. A multivariate analysis was conducted and identified preoperative atrial fibrillation and intraoperative hypothermia as predictive risk factors for FTF. Conclusions According to our retrospective single-center analysis, extubation in the operating room is feasible and safe even outside of a structured ERAS program. However, as itself it does not impact the further hospital stay, if there is no action thereafter, e.g., same day physiotherapy.
Bauer et al. (Mon,) studied this question.