• Jore Hendrikx, Maxim Timmers, Layth AlTmimi, Danny F Hoogma, Johan De Coster, Steffen Fieuws, Paul Herijgers, Filip Rega, Peter Verbrugghe, and Steffen Rex.
• Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt A): 2463-2472.

ObjectivesAn important cornerstone of the Enhanced Recovery After Cardiac Surgery initiative is a fast-track cardiac anesthesia management protocol. Fast-track failure has been described to have a detrimental impact on immediate postoperative outcomes. The authors here evaluated risk factors for short- and long-term effects of fast-track failure.DesignA retrospective cohort study.SettingA single academic center.ParticipantsAdult cardiac surgery was performed on 7,064 patients between January 2013 and October 2019.InterventionThe inclusion criteria for the fast-track program at the postanesthesia care unit were met by 1,097 patients.Measurements And Main ResultsUnivariate and multivariate logistic regression analyses were used to identify independent risk factors. Fast-track failure occurred in 69 (6.3%) patients. These were associated with significant increases in the incidences of coronary revascularization, cardiac tamponade or bleeding requiring surgical intervention, new-onset atrial fibrillation, pneumonia, delirium, and sepsis. Likewise, the postoperative length of stay, and up to 5-year mortality, were significantly higher in the fast-track failure than the nonfailure group. The European System for Cardiac Operative Risk Evaluation II and transfusion of any blood product could be identified as independent risk factors for fast-track failure, with only limited discriminative ability (area under the curve = 0.676; 95% confidence interval, 0.611-0.741).ConclusionFast-track failure is associated with increases in morbidity and long-term mortality, but remains difficult to predict.Copyright © 2021 Elsevier Inc. All rights reserved.

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