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

PURPOSE: Perioperative fast-track management has gained wide acceptance in the field of neonatal corrective heart surgery. We have examined its impact on morbidity outcomes.
METHODS: 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).
RESULTS: 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).
CONCLUSIONS: Fast-track management with simple care for neonates undergoing complete biventricular repair of congenital heart defects was associated with better postoperative recovery.