Early Recovery With a Fast-Track Program: Initial Experience in Paediatric Cardiac Surgery

Abstract

Introduction: Early Recovery After Surgery (ERAS) or Fast-Track (FT) programs are common in many surgical specialities but uncommon after paediatric cardiac surgery. The aim of this pilot study was to evaluate our initial experience with this new postoperative model of care. Methods: Patients suitable for FT were identified pre-operatively based on specific criteria (type of procedure; absence of major non-cardiac or developmental abnormalities). The program focussed on optimising early postoperative analgesia including parasternal topical analgesia soaker catheters and same day discharge from the ICU to the ward. All data was collected prospectively. Results: Thirty-four patients were deemed suitable for FT. Median age was 4.5 years (range 0.5–14 years). Median weight was 19 kg (range 6.3-80 kg). Procedures included ASD (n=19), VSD (n=3), and vascular ring (n=7). Thirty patients (88%) were extubated on table. No patient required reintubation. Twenty-eight (82%) patients were discharged from ICU to the ward on the day of surgery. Five (15%) patients met criteria for discharge from ICU on the day of surgery but could not be transferred due to bed unavailability on the ward. One patient did not meet early discharge criteria due to fever. Median ICU stay was 4.8 hours (range 1-6.8 hrs). No patients required readmission to the ICU. Conclusions: FT recovery in paediatric cardiac surgery is feasible and can be implemented safely in a selected group of patients. Ward bed availability is a potential barrier to FT implementation. FT reduces ICU stay and has the potential to improve the patient/family experience.L20138245222022-03-11 <br />