A Coronary Artery Bypass “Fast-Track” Protocol Is Practical and Realistic in a Rural Environment

Background. In this study we determine retrospectively whether assignment of all patients undergoing coronary artery bypass grafting to a “fast-track” protocol (FT) is practical and realistic in our rural institution. Methods. We compared the outcome of 266 consecutive patients undergoing coronary artery bypass grafting who were fast-tracked in 1996 with that of 266 consecutive patients who were managed conventionally (NFT) in 1994. The surgical techniques were comparable in both groups; however, FT anesthesia used inhalational agents and short-acting narcotics. All comparisons were performed using the Student’s t test or the χ2 test. Results. Postoperatively 95% of the FT group were extubated by 24 hours compared with 0% in the NFT group (p < 0.0001). The mean intensive care unit length of stay in the FT group was 1.7 ± 0.8 days, whereas it was 2.6 ± 0.6 days in the NFT group (p < 0.001). The mean postoperative length of stay was 6.4 ± 1.2 days in the FT group compared with 7.5 ± 0.9 days in the NFT group (p < 0.001). There were no significant differences in 30-day morbidity/mortality. There was a substantial cost savings in the FT group. Conclusions. The fast-track protocol can be successful without any compromise of patient care. Early discharge from the hospital, however, is not always feasible.