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A comprehensive approach to fast tracking in cardiac surgery: ambulatory low-risk open-heart surgery

^a Department of Cardiovascular and Thoracic Surgery, G.B. Pant Hospital, New Delhi, India
^b Department of Cardiac Anesthesia, G.B. Pant Hospital, New Delhi, India

Received 24 October 2007; received in revised form 4 February 2008; accepted 15 February 2008.

^_* Corresponding author. Address: E-194 Saraswati Kunj, Plot No. 25, I.P. Extension, Patparganj, Delhi, India. Tel.: +91 9868367495. (Email: aseem_ranjan{at}hotmail.com).

Objective: Ambulatory surgery, where the processes of admission, surgery and discharge are completed within 24 h, is an increasingly important part of many surgical specialties. The aim of this study was to evaluate suitability of ambulatory approach for low-risk open-heart procedures. Methods: A retrospective analysis of 48 patients who had undergone atrial septal defect (ASD) closure at our centre (from October 2005 through November 2006) suggested that this open-heart procedure was optimally suited for treatment with ambulatory approach. Based on this, 15 patients with ostium secundum ASD underwent surgical closure as ambulatory patients, with targeted discharge within 24 h of admission. Twenty patients receiving conventional surgery in the other two units of the department served as the control group. Results: Fourteen of the 15 patients were successfully discharged within 24 h of admission. One patient remained in the hospital for excess incision site pain and was discharged on the 2nd postoperative day. Mean hospital stay for the entire cohort of 15 patients was 1583 ± 669 min, whereas the mean hospital stay in the control group was 9.8 days. Follow-up was 100% complete at 30 days. There were no in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from the procedure. Conclusions: This study suggests that sufficient advancement in cardiac surgery has occurred to permit low-risk open-heart procedures (with an expected uneventful postoperative course) to be performed on an ambulatory basis. Once such a practice is firmly established, expanding its horizon may provide considerable improvement in patient satisfaction, more patient turnover per bed, and significant financial savings.

Key Words: Ambulatory cardiac surgery • Ambulatory ASD closure