A novel nomogram for predicting the implementation of ultra-fast-track cardiac anesthesia for minimally invasive cardiac surgery

Background Ultra-fast-track cardiac anesthesia (UFTCA) is a crucial component of Enhanced Recovery After Cardiac Surgery (ERACS). However, research on the factors influencing UFTCA implementation remains limited. This study aimed to identify predictors of UFTCA in right-thoracoscopic minimally invasive cardiac surgery (MICS) and develop a nomogram to forecast UFTCA implementation. Methods This retrospective study included 947 patients who underwent right-thoracoscopic MICS from January 2021 to July 2023. Patients were randomly divided into derivation (70%) and validation (30%) cohorts. Univariable logistic regression analysis was used for variable selection, followed by a multivariable logistic regression model to determine significant predictors and construct a nomogram for forecasting UFTCA implementation. The model's discrimination, calibration, and clinical usefulness were evaluated using the validation cohort. Results Multivariate analysis identified six independent predictors of UFTCA implementation: operation type, fascial plane chest wall blocks (FPCWB), intraoperative sufentanil and dexamethasone dosage, operation later than 8 p.m., and cardiopulmonary bypass (CPB) duration. The nomogram demonstrated good discriminative ability, with areas under the receiver operating characteristic (ROC) curve of 0.869 and 0.862 for the derivation and validation sets, respectively. The calibration plot showed close alignment with the ideal diagonal line, and the decision curve analysis (DCA) confirmed the model's clinical practical significance. Conclusion This study developed and validated a nomogram that could predict the implementation of UFTCA in patients undergoing MICS. The identified predictors, including operation type, FPCWB, intraoperative sufentanil and dexamethasone dosage, operation later than 8 p.m., and CPB duration, could guide clinicians in decision-making to facilitate UFTCA implementation.