A pattern of consistent evolution in fast-track protocol s was clearly demonstrated and these have shown variations in the core-identified components across the studies .
In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment
Fast track is a st and ardised goal directed patient 's care pathway that aims to facilitate recovery following surgery .
Currently , there are large variations in the fast track protocol s used in oesophagectomy due to the complexity of the procedure .
The objective of this systematic review is to assess the evolution of fast track protocol s  following oesophagectomy  since its implementation and the result ing effect on postoperative outcomes .
The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay.
OBJECTIVE To determine if lengths of stay in intensive care and the hospital are associated with extubation in the operating room at the conclusion of cardiac surgery . DESIGN A nonr and omized , observational study with propensity score-guided case-control matching of prospect ively collected data . SETTING Three interrelated , university-affiliated , community hospitals . PARTICIPANTS Three thous and three hundred seventeen patients undergoing elective or urgent coronary artery , valve repair or replacement , or combined surgery between 2000 and 2006 . INTERVENTIONS  Tracheal extubation  occurred , based on history and intraoperative events , either immediately in the operating room or in the intensive care unit . MEASUREMENTS AND MAIN RESULTS Of 3,317 patients in the institutions ' Society of Thoracic Surgeons data base , 3,089 were extubated within 24 hours , 69 % of them in the operating room . Only 0.6 % of patients extubated in the operating room required reintubation , compared with 5.9 % extubated in the intensive care unit ( p < 0.0001 ) . By logistic regression , 12 of 25 preoperative and intraoperative factors generated a propensity score for each of the 2,595 patients with complete data , representing the likelihood of immediate extubation ( c-statistic = 0.727 ) . A " greedy 5 to 1 " propensity score-matching technique created 713 matched pairs of patients by extubation pathway . Those undergoing immediate extubation had reductions in intensive care duration by 23 hours on average ( median from 46 to 27 hours , p < 0.0001 ) and in hospital length of stay by 0.8 days on average ( median = 6 for each , p < 0.0001 ) . Cox regression , using matched pairs as strata , identified the following independent predictors of length of stay in the intensive care unit and hospital : immediate extubation in the operating room , need for reintubation , postoperative renal failure , and postoperative atrial fibrillation . CONCLUSIONS Selection of patients for immediate extubation in the operating room by experienced clinicians was associated with shorter ICU and hospital stays . Immediate extubation rarely result ed in tracheal re-intubation
A pattern of consistent evolution in fast-track protocol s was clearly demonstrated and these have shown variations in the core-identified components across the studies .
In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment
Fast track is a st and ardised goal directed patient 's care pathway that aims to facilitate recovery following surgery .
Currently , there are large variations in the fast track protocol s used in oesophagectomy due to the complexity of the procedure .
The objective of this systematic review is to assess the evolution of fast track protocol s  following oesophagectomy  since its implementation and the result ing effect on postoperative outcomes .