A short stay in the ICU is safe and cost effective for low-risk patients who have undergone coronary artery bypass grafting, according to Ghislaine van Mastrigt of Maastricht (the Netherlands) University Hospital and associates.
A “fast-track” ICU stay of 8 hours or less “can be considered as an alternative to conventional postoperative ICU treatment for low-risk CABG patients,” the researchers said.
They assessed the safety of early ICU discharge in a study of 600 CABG patients after noting that “fast-track treatment after cardiac surgery is becoming very popular, although evidence-based research on safety and cost effectiveness is limited.”
A total of 300 subjects were randomly assigned to a short ICU stay and 300 to a conventional overnight stay in the ICU after CABG surgery at the university hospital between 2001 and 2003. Mean patient age was 62 years, and 80% of the patients were men. The rate of readmission to the ICU was 2.7% (eight patients) in the short-stay group and 1.3% (four patients) in the control group, a difference that was not statistically significant. There also were no significant differences between the two groups in postoperative morbidity, 30-day mortality, or total hospital stay, the investigators said (Crit. Care Med. 2006:34:65–75)
There was a small but significant advantage in quality of life measures for the short-stay group, “However, it is questionable whether [quality of life] improvement is clinically relevant,” Ms. Mastrigt and associates noted.
Hospital costs were significantly lower for the fast-track patients, mainly because their stays in the high-cost ICU were a mean of 11 hours shorter than those in the conventional-care group. The short-stay group also had fewer of the laboratory tests that are usually done in the ICU. Costs of other routine hospital care and outpatient procedures were comparable for the two groups.