Fast-track postoperative care for neonatal cardiac surgery: a single-institute experience

Abstract

Perioperative fast-track management has gained wide acceptance in the field of neonatal corrective heart surgery. We have examined its impact on morbidity outcomes. Between 1997 and 2009, 52 consecutive neonates underwent corrective repair of congenital heart defects on cardiopulmonary bypass. Fast-track management was introduced in 2006 with the aim of simplifying care; it includes early postoperative extubation with low-dose fentanyl and an pulse oximeter oxygen saturation (SpO(2)) target of ≤ 95%, early removal of indwelling lines, and early introduction of early enteral feeding. This was a retrospective review of the medical records in which perioperative characteristics and outcomes of patients operated on prior to the introduction of fast-track management care (controls, group C) were compared with those operated on following its introduction (fast-track group, group F). Intraoperative fentanyl was administered in significantly lower doses in group F (29.5 ± 11.5 μg/kg) than in group C (65.6 ± 34.0 μg/kg) (p < 0.001). The median number of days of postoperative mechanical ventilation and inotrope administration was significantly lower in group F (2 and 4 days, respectively) than in group C (9 and 9 days, respectively) (p < 0.001 and p = 0.003). More patients (p < 0.001) in group F (56.3%) than in group C (0%) was extubated within <24 h. The median number of days to postoperative weight recovery was significantly lower in group F (16 days) than in group C (29 days) (p = 0.003). Finally, the median number of days in the Intensive Care Unit was significantly lower (p = 0.01) in group F than in group C (16 vs. 26 days, respectively). Mortality in group F was 0% versus 17% in group C (p = 0.21). Fast-track management with simple care for neonates undergoing complete biventricular repair of congenital heart defects was associated with better postoperative recovery.