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Objective <p>We performed retrospective study to determine whether early management of analgesia by intensivists reduced opiate utilization and improved patient outcomes at our institution.</p> Methods <p>Consecutive patients undergoing primary sternotomy for coronary artery bypass graft, valve were studied. Those who underwent aortic dissection patients, non-sternotomy (e.g. thoracotomy), mechanical ventilation longer than 24&#xa0;h, history of drug addiction, re-do sternotomy, or that required take back to surgery for anything during the index hospitalization were excluded from study. New analgesia intervention was started in June 2022 with our designated cardiothoracic surgery intensivists. Primary endpoint of the study was required analgesia based on morphine equivalent dose (MED) after surgery, and secondary endpoints were ICU length of stay (LOS), total hospital LOS, in-hospital mortality, 30-day readmission. These endpoints were compared pre-intervention period (May 2021 till June 2022) and post-intervention period (June 2022 till May 2023).</p> Results <p>A total of 615 fast-track patients (307 in the pre-intervention group and 308 in the post-intervention group) were analyzed. MED was significantly less in the post-intervention group 223&#xa0;mg MED than the pre-intervention group 275&#xa0;mg MED, <i>p</i> &lt; 0.0001. There was shorter ICU LOS in post-intervention group (3.0 days in post-intervention group) than in pre-intervention group 5.0 days (<i>p</i> &lt; 0.0001). There was no difference in-hospital mortality, or 30-day readmission rate.</p> Conclusions <p>Early Intensivist driven analgesic titration reduces opiate utilization and ICU length of stay without increase of post-operative complications or re-admission rate.</p>

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Early intensivist driven analgesic intervention in ICU vs. surgeon driven analgesia in fast-track post-sternotomy patients in private community cardiac surgery center

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月8日

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  • Ramsey D. Sitta,
  • Qiong Yang,
  • Hitoshi Hirose

摘要

Objective

We performed retrospective study to determine whether early management of analgesia by intensivists reduced opiate utilization and improved patient outcomes at our institution.

Methods

Consecutive patients undergoing primary sternotomy for coronary artery bypass graft, valve were studied. Those who underwent aortic dissection patients, non-sternotomy (e.g. thoracotomy), mechanical ventilation longer than 24 h, history of drug addiction, re-do sternotomy, or that required take back to surgery for anything during the index hospitalization were excluded from study. New analgesia intervention was started in June 2022 with our designated cardiothoracic surgery intensivists. Primary endpoint of the study was required analgesia based on morphine equivalent dose (MED) after surgery, and secondary endpoints were ICU length of stay (LOS), total hospital LOS, in-hospital mortality, 30-day readmission. These endpoints were compared pre-intervention period (May 2021 till June 2022) and post-intervention period (June 2022 till May 2023).

Results

A total of 615 fast-track patients (307 in the pre-intervention group and 308 in the post-intervention group) were analyzed. MED was significantly less in the post-intervention group 223 mg MED than the pre-intervention group 275 mg MED, p < 0.0001. There was shorter ICU LOS in post-intervention group (3.0 days in post-intervention group) than in pre-intervention group 5.0 days (p < 0.0001). There was no difference in-hospital mortality, or 30-day readmission rate.

Conclusions

Early Intensivist driven analgesic titration reduces opiate utilization and ICU length of stay without increase of post-operative complications or re-admission rate.