{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:01:17Z","timestamp":1793192477934,"version":"4.5.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Fast-track extubation is a key component of the interdisciplinary treatment concept Enhanced Recovery After Surgery (ERAS). In preparation for implementing ERAS as a comprehensive approach, we aimed to analyze the current state of fast-track extubation in the operating room, focusing on Minimally Invasive Cardiac Surgery (MICS). Specifically, we assessed the potential benefits of immediate on-table extubation compared to extubation within six hours after the completion of MICS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>During a 4-year period from 2019\u20132023, a total of <jats:italic>n<\/jats:italic>\u2009=\u2009146 patients underwent MICS at our institution. Surgical aspects were retrospectively analysed along with patients' risk profiles and relevant comorbidities. After 1:1 best neighbor propensity score matching, patients who were admitted to intensive care unit intubated but were extubated within six hours after surgery (fast-track, FT) were compared to those who were extubated in the operating room (extubation in tabula, EIT). The primary endpoint was fast-track failure (FTF), a composite of setbacks in the postoperative course: revision surgery, re-intubation, and readmission to ICU or intermediate care unit (IMC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients had a median age of 61 years (IQR: 51.3\u201367.8) and were predominantly male (76.7%). The primary study endpoint occurred in 20.0% of all matched patients (FT: 26.7%, EIT: 13.3%; <jats:italic>p<\/jats:italic>\u2009=\u20090.289). FT patients had longer cardiopulmonary bypass times [FT 165.0\u2005min (146.5\u2013217.5); EIT 158.5\u2005min (128.0\u2013189.5); <jats:italic>p<\/jats:italic>\u2009=\u20090.047], but the duration of surgery was comparable. Additionally, the average length of hospital stay did not differ. A multivariate analysis was conducted and identified preoperative atrial fibrillation and intraoperative hypothermia as predictive risk factors for FTF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>According to our retrospective single-center analysis, extubation in the operating room is feasible and safe even outside of a structured ERAS program. However, as itself it does not impact the further hospital stay, if there is no action thereafter, e.g., same day physiotherapy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1567533","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T05:26:26Z","timestamp":1757309186000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Fast-track extubation in minimally invasive cardiac surgery: limits and lessons of a 4-year single-center analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Sebastian Johannes","family":"Bauer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz Benjamin","family":"Immohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friederike 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