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Editorial

Fast track: are surgeons pushing the envelope too far in cardiac surgery?

University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA

^_* Corresponding author. (Email: tsalerno@med.miami.edu).

The first 20% of the full text of this article appears below.

Pressure from a variety of sources, mostly from HMOs and insurance companies, has resulted in certain surgical procedures being performed utilizing a very short hospital stay (fast track). Cholecystectomy, a procedure that required pre-admission to the hospital, and rather prolonged hospital stay, has almost become an outpatient procedure. As a requisite, patients are fully worked up prior to admission, are admitted the same day of surgery, and are operated upon hours later. Extubation is commonly performed in the operating room and, later the same day or the next morning, the patient is discharged to be followed-up in a clinic. Advantages of this approach include patient comfort and cost containment for payers. In the United States, insurance companies usually have to be informed of the patient's need for surgery and have to pre-approve the procedure as well as the number of days they will be allowed in the hospital for surgery. Extra days are usually denied for payment, unless there is an appeal submitted by the surgeon or by the appropriate hospital authorities. By proposing surgical care strategies such as those recommended by Srivastava et al. [1], surgeons are creating new standards that will be difficult to replicate, especially in certain medical domains, where the complexity of patients treated is increasing as a result of serious comorbidities. In cardiac surgery, . . . [Full Text of this Article]