To the Editor:—
We read with great interest, “Cardiac Surgery Fast-track Treatment in a Postanesthetic Care Unit” by Dr. Ender et al. 1Application of this fast-track concept in Leipzig has been met with good results for a wide variety of cardiac surgical patients. Modern perioperative management is faced with the challenge of finding a balance between safe and efficacious results. The objective of fast-track cardiac surgery includes early extubation, reduction of intensive care unit length of stay, and reduction of the total hospital length of stay. This is accomplished with the use of short-acting opioids and hypnotics along with expeditious surgical procedures facilitating early extubation after cardiac surgery. In addition the Leipzig fast-track concept avoids intensive care unit admission in selected patients. Similarly, our institution attempts to expedite the management of cardiac patients by using a preanesthetic clinic specialized for day admission cardiac and major vascular surgeries. Day admission surgery is nearly routine in the United States due to desires to decrease costs and resource utilization. Addition of such a preanesthetic clinic to the Leizpig fast-track method would further decrease costs by several mechanisms. Preanesthestic clinics specialized for cardiac and major vascular surgery (thoracic aortic aneurysm) patients are useful to ensure patient safety in a complicated population while avoiding unnecessary expenditures. Furthermore, enhancement of patient satisfaction throughout the surgical process is documented with specialized cardiac preanesthetic clinics.2A combination of a specialized preanesthetic clinic and the Leipzig fast-track concept may provide the necessary link in modern cardiovascular perioperative medicine in order to safely decrease costs.
*Mount Sinai School of Medicine, New York, New York. george.silvay@msnyuhealth.org
