TITLE:
Fast Tracking after Repair of Tetralogy of Fallot —A Retrospective Analysis in a Govt Hospital
AUTHORS:
Pares Bandyopadhyay, Binay Krishna Sarkar, Vijay Agarwal
KEYWORDS:
Tetralogy of Fallot (TOF), Early Extubation, Fast Track Protocol, Mortality, Discharge
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.16 No.6,
August
11,
2026
ABSTRACT: Introduction: In many centers like ours specific paediatric post cardiac surgery ICU with dedicated and trained manpower for paediatric ICU care is not available after all paediatric cardiac surgeries. As a result, patients in those centers develop more post op morbidity and mortality due to complications related to prolonged ventilation, sedation, analgesia, and nasogastric feeding. To get rid of such problems and reduce morbidy and mortality the early extubation and fast track protocol has become a treatment of choice in many centers. Method: This retrospective observational study was done at the department of cardiothoracic surgery NRS Medical College on the basis of data recorded over a period of 4 years (from Jan 2022 to Dec 2025). This study was based on all isolated Tetralogy of Fallot cases operated consecutively at this department during that period and their data was retrieved from departmental and hospital records including RBSK Excel data sheet, records from OT, perfusion data, central records and personal communications with patient’s families. This data retrieval and analysis was done during a period of 2 months (April and May 2026). So such analysis was purely retrospective, post facto, and observational. During analysis we have considered discharge of the patients as early when it is less or equal to 7 days and late when it is more than 7 days. Mortality was considered as in hospital mortality after surgery within 30 days. Results: Total 60 isolated TOF patients were operated consecutively during 4 years (Jan 2022 to Dec 2025). Of them 3 patients, were excluded as their extubation time was more than 24 hours. We have considered only 57 patients who were extubated within 24 hours after operation and classified them into 2 groups, accepting the terminology defined by Schmidt and Malec in 2019, (Page 491, Ref 1). 43 patients were categorised in group I as fast track protocol group who had undergone extubation within 6 hours of the end of surgery and 14 patients in group II as Early extubation (Traditional) protocol who were extubated within 6 to 24 hours after operation. The different variables and outcomes between those two groups has been compared by Fisher’s exact Test (Odds ratio and p-value analysis). Conclusion: In this study outcome between two groups has been compared and the patients of fast track protocol group (group I) had significantly low in hospital mortality and early hospital discharge (less or equal to 7 days) in comparison to traditional early extubation protocol (group II).