Is Early Recovery Possible After Congenital Cardiothoracic Surgery?

Abstract

Background: The primary aim of this study was to implement the fast-track (FT) model of care in eligible children following paediatric cardiac surgery. Method: A mixed-methods cohort implementation study was performed. Every child presenting for surgery aged 0–18 years was eligible for study inclusion. Neonates requiring open-heart surgery, patients undergoing univentricular or complex re-do surgery and with pre-existing airway issues or significant comorbidities were ineligible. Using the FT model of care, patients were expected to discharge to the ward from the paediatric intensive care unit (PICU) the same day as surgery. Pathway implementation was guided by the Promoting Action on Research Implementation in Health Services framework. Results: Seventy-one patients were deemed suitable for FT between October 2019 and May 2022. The median (IQR) age of participants was 5 years (3, 10) and median (IQR) weight was 20 kg (14, 39). Primary procedures included atrial septal defect repair, partial atrioventricular septal defect (AVSD) repair, aortic stenosis repair, partial anomalous pulmonary venous connection repair, ventricular septal defect repair, coarctation repair, right ventricular-pulmonary artery conduit replacement, right ventricular outflow tract repair, and pulmonary artery reconstruction. Most patients (86%, n=61) successfully transferred to the ward on the same day. Ten patients (14%) were unable to transfer to the ward on the same day due to bed availability (50%, n=5), medical reasons (30%, n =3), and communication issues (10%, n=1). The median (IQR) time patients spent in PICU was 4.5 hours (4.2, 5.3). Fifty-seven (93%) successful FT patients were extubated in the theatre. The average hospital length of stay was 4.5 days (±1.3). No patients required re-intubation or re-admission to PICU. Conclusion: Fast-track in congenital cardiothoracic surgery is possible and can be safely implemented in a select group of patients. Step-down bed availability is a significant contributor to failures of FT. Most FT patients can be safely extubated before transfer to PICU.