Ultra-fast-track anesthesia reduced postoperative length of stay compared to conventional general anesthesia in elderly patients undergoing minimally invasive cardiac surgery (mean ratio 0.889).
Cohort (n=584)
No
Does an ultra-fast-track anesthesia perioperative pathway reduce postoperative length of stay and improve recovery in elderly patients undergoing minimally invasive cardiac surgery compared to conventional general anesthesia?
An ultra-fast-track anesthesia pathway is feasible in elderly patients undergoing minimally invasive cardiac surgery and is associated with significantly shorter postoperative hospital and ICU lengths of stay.
Effect estimate: Mean ratio 0.889 (95% CI 0.803-0.985)
Absolute Event Rate: 8% vs 9%
p-value: p=0.025
Ultra-fast-track anesthesia (UFTA) has been increasingly used in adults undergoing minimally invasive cardiac surgery (MICS), but evidence in elderly patients remains limited. We evaluated the feasibility and clinical outcomes of UFTA compared with conventional general anesthesia (CGA) in elderly patients undergoing MICS. We conducted a retrospective study of patients aged ≥ 65 years who underwent MICS at our center between January 2022 and December 2024. Patients were categorized into a UFTA-based perioperative pathway group, in which extubation was performed in the operating room within 1 h after surgery when predefined criteria were met, and a CGA group, in which extubation occurred in the ICU. The primary endpoint was postoperative length of stay (LOS). Secondary endpoints were: ICU stay duration, duration of inotropic and vasoactive support, time to extubation, major postoperative complications, and 30-day outcomes. Of the 584 cases that met the inclusion criteria, 430 were successfully matched at a 1:1 ratio, resulting in two well-balanced groups of 215 patients each. In the matched cohort, patients managed with the UFTA-based perioperative pathway had a shorter postoperative LOS (median IQR, 8 7–11 vs. 9 7–12 days; mean ratio 0.889 95% CI 0.803–0.985; P = 0.025), shorter ICU stay (26 22–45 vs. 46 28.5–72 hours; mean ratio 0.641 95% CI 0.441–0.933; P = 0.020), and shorter duration of inotropic and vasoactive support (2 1–2 vs. 3 2–4 days; mean ratio 0.570 95% CI 0.486–0.669; P < 0.001). Time to extubation was markedly shorter in the UFTA group (10 5–15 vs. 630 540–1020 minutes; mean ratio 0.015 95% CI 0.013–0.018; P < 0.001). Respiratory insufficiency and delirium were less frequent in the UFTA group, although these secondary complication findings should be interpreted cautiously. In this propensity score-matched cohort of elderly patients undergoing MICS, the UFTA-based perioperative pathway was feasible and was associated with shorter postoperative LOS and ICU stay, as well as a shorter duration of pharmacologic hemodynamic support. Further prospective multicenter studies with standardized outcome assessment are needed to confirm these findings and to better define appropriate candidates.
Zhou et al. (Fri,) conducted a cohort in Minimally invasive cardiac surgery (MICS) (n=584). Ultra-fast-track anesthesia (UFTA) vs. Conventional general anesthesia (CGA) was evaluated on Postoperative length of stay (LOS) (Mean ratio 0.889, 95% CI 0.803-0.985, p=0.025). Ultra-fast-track anesthesia reduced postoperative length of stay compared to conventional general anesthesia in elderly patients undergoing minimally invasive cardiac surgery (mean ratio 0.889).