Authors: Cotovanu AGM et al.
Journal of Cardiothoracic and Vascular Anesthesia. 2025.
Summary
This prospective cohort study evaluated the feasibility and safety of an ultrafast track (UFT) integrated care pathway designed to enable intensive care unit (ICU) stepdown within 6 hours after low-risk cardiac surgery. The pathway was anesthesia-led and focused on streamlined perioperative management, early extubation, and rapid postoperative recovery in a carefully selected patient population.
The study included 261 adult patients undergoing elective or urgent coronary artery bypass grafting, aortic valve replacement, or mitral valve repair at a single university medical center in the Netherlands. All patients met strict low-risk criteria, including a EuroSCORE II of less than 3% and additional institutional selection parameters. The primary endpoint was successful completion of the UFT pathway, defined as ICU discharge within 6 hours of surgery.
UFT completion was achieved in 80.1% of patients. Nearly two-thirds of the cohort were extubated in the operating room immediately after surgery, highlighting the central role of anesthetic management in facilitating early recovery. Reintubation was uncommon and was predominantly related to the need for reoperation rather than primary respiratory failure. Importantly, there was no 30-day mortality, and overall survival at follow-up was 97%.
Patients who successfully completed the UFT pathway demonstrated more favorable postoperative profiles, including lower cardiac biomarkers and creatinine levels, reduced mediastinal and pleural drain output, fewer reoperations, and a shorter hospital length of stay compared with those who did not meet UFT criteria. These findings suggest that early ICU stepdown was not only safe but also associated with improved efficiency and resource utilization without compromising clinical outcomes.
Key Points
An anesthesia-led ultrafast track pathway enabled ICU stepdown within 6 hours in over 80% of carefully selected low-risk cardiac surgery patients.
Early extubation, including in the operating room, was feasible and central to successful pathway completion.
No 30-day mortality and low reintubation rates support the safety of this approach.
Successful UFT patients experienced fewer complications and shorter hospital length of stay.
This model demonstrates a scalable strategy to improve ICU bed utilization while maintaining high-quality outcomes.
Thank you for allowing us to review and summarize this important fast-track recovery study published in the Journal of Cardiothoracic and Vascular Anesthesia.