Interdisciplinary fast track protocol versus conventional management in paediatric cardiac surgery - a propensity matched retrospective analysis

Objectives Enhanced recovery after surgery (ERAS) programs have been shown to improve postoperative outcomes and have been well extended to cardiac surgical patients. We aimed to evaluate the safety and efficacy of predefined FT protocol in paediatric cardiac surgery. The primary endpoints were extubation time and length of stay in ICU. Secondary endpoints were postoperative complications, postoperative mortality, and length of stay in the hospital. Study design In this retrospective study, patients treated with a fast-track protocol (FT) were compared with a propensity score matched control group (C) with conventional anaesthesia management. Results In both groups, 118 pts were included. FT protocol significantly reduced ventilation time 83(182) minutes vs. 1150(2243) minutes, p < 0.001 and ICU LOS 70(65) hours vs. 94(95) hours, p = 0.02. FT group also showed fewer infection rates (2.5% vs. 9.3% p = 0.03), stridor (3.4% vs. 16% p < 0.001), pericardial effusion (2.5% vs. 12.7% p = 0.003), and incidence of delirium (6.8% vs. 17% p = 0.016). The reduction of hospital LOS 11.5(9) days vs. 13.5(8.8) days, p = 0.08 was not significant. Postoperative mortality was 0% in both groups. Conclusion Using predefined fast-track protocol and strict patient selection criteria, early extubation and mobilization reduced LOS in ICU and postoperative complications without increasing perioperative morbidity and mortality.