Economic and safety implications of introducing fast tracking in congenital heart surgery

Circ Cardiovasc Qual Outcomes. 2013 Mar 1;6(2):201-7. doi: 10.1161/CIRCOUTCOMES.111.000066. Epub 2013 Feb 26.


Background: The feasibility of fast-tracking children undergoing congenital heart disease surgery has not been assessed adequately. Current knowledge is based on limited single-center experiences without contemporaneous control groups.

Methods and results: We compared administrative data for atrial septal defect (ASD) and ventricular septal defect (VSD) surgeries in children 2 months to 19 years of age at the Mount Sinai Medical Center (MSMC) with data from comparable patients at 40 centers contributing to the Pediatric Health Information System. Three-year blocks, early in and after fast tracking had been implemented at the MSMC, were examined. Seventy-seven and 89 children at MSMC undergoing ASD and VSD closure, respectively, were compared with 3103 ASD and 4180 VSD patients nationally. With fast tracking fully implemented, median length of stay at the MSMC decreased by 1 day compared with the earlier era (length of stay, 1 and 3 days for ASD and VSD, respectively). Nationally, median length of stay remained unchanged (3 days for ASD and 4 days for VSD) in the observed time periods. Hospitalization costs fell by 33% and 35% at MSMC (ASD and VSD, respectively), whereas they rose by 16% to 17% nationally. When analyzed in multiple regression models, the decrease in both length of stay and cost remained significantly greater at MSMC compared with nationally (P<0.0001 for all). Hospital mortality and 2-week readmission rates were unchanged at MSMC between the 2 time periods and were not different from the national rates.

Conclusion: Shorter length of stay and cost savings compared with national data were observed after implementation of fast tracking.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiac Surgical Procedures / economics*
  • Cardiac Surgical Procedures / mortality
  • Child
  • Child Mortality
  • Child, Preschool
  • Cost Savings
  • Cost-Benefit Analysis
  • Feasibility Studies
  • Female
  • Health Services Research
  • Heart Septal Defects, Atrial / economics
  • Heart Septal Defects, Atrial / mortality
  • Heart Septal Defects, Atrial / surgery*
  • Heart Septal Defects, Ventricular / economics
  • Heart Septal Defects, Ventricular / mortality
  • Heart Septal Defects, Ventricular / surgery*
  • Hospital Costs*
  • Hospital Mortality
  • Humans
  • Infant
  • Infant Mortality
  • Length of Stay / economics
  • Male
  • Outcome and Process Assessment, Health Care / economics*
  • Patient Readmission / economics
  • Regression Analysis
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • United States
  • Young Adult