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Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass
Artur H Herdy1, Patrícia L B Marcchi, Adriano Vila
1Santa Catarina Heart Institute, Florianópolis, Brazil.
Insights
Pre- and postoperative cardiopulmonary rehabilitation significantly improves outcomes for patients awaiting coronary artery bypass surgery (CABG). This program reduces complications and shortens hospital stays compared to standard care.
Area of Science:
- Cardiology
- Pulmonology
- Rehabilitation Medicine
Background:
- Immobilization poses risks for patients awaiting coronary artery bypass surgery (CABG).
- In-hospital rehabilitation programs may mitigate these risks and improve surgical outcomes.
Purpose of the Study:
- To evaluate the impact of a pre- and postoperative cardiopulmonary rehabilitation program on outcomes in patients awaiting CABG.
- To compare the efficacy of this rehabilitation program against usual care.
Main Methods:
- Fifty-six patients awaiting CABG were randomized into a rehabilitation group (n=29) or a control group (n=27).
- The rehabilitation program included phase I cardiac rehabilitation and respiratory physical therapy for at least 5 days preoperatively until discharge.
- Outcomes were assessed through blind evaluation.
Main Results:
- The rehabilitation group showed a significantly shorter time to endotracheal extubation (P=0.05).
- Reduced incidence of pleural effusion (RR=0.2), atelectasis (RR=0.15), pneumonia (P=0.004), and atrial fibrillation/flutter (RR=0.2) was observed in the rehabilitation group.
- The length of in-hospital stay after surgery was significantly reduced in the rehabilitation group (P<0.001).
Conclusions:
- Pre- and postoperative cardiopulmonary rehabilitation is superior to standard care for patients awaiting CABG.
- This rehabilitation approach leads to a decreased rate of postoperative complications.
- The program effectively shortens the duration of hospital stay post-CABG.
Objective:
Patients who have to wait in the hospital for coronary artery bypass surgery (CABG) are exposed to the potential risks of immobilization. This clinical trial was conducted to evaluate the effects of an in-hospital cardiopulmonary rehabilitation program performed before and after CABG on postoperative outcomes.
Design:
Fifty-six patients who had to wait for CABG in-hospital were randomly assigned to a cardiopulmonary rehabilitation (Rehab; n = 29) or to usual care (Control; n = 27). In the Rehab group, intervention lasted for at least 5 days preoperatively until discharge. The program consisted of phase I cardiac rehabilitation associated with respiratory physical therapy. Outcomes were blindly evaluated.
Results:
By hospital discharge, Rehab patients presented a shorter time to endotracheal extubation (1054 +/- 376 vs. 1340 +/- 666 min, P = 0.05), a reduction in the incidence of pleural effusion (relative risk [RR] = 0.2; 95% confidence interval [CI]: 0.5-0.8), atelectasis (RR = 0.15; 95% CI: 0.03-0.8), pneumonia (0 vs. 7 cases, [P = 0.004]), and atrial fibrillation or flutter (RR = 0.2; 95% CI: 0.05-0.8). Length of in-hospital stay after surgery was also reduced in the Rehab group (5.9 +/- 1.1 vs. 10.3 +/- 4.6 days [P < 0.001]).
Conclusion:
Pre- and postoperative cardiopulmonary rehabilitation in patients who await CABG in the hospital is superior to standard care and leads to a reduced rate of postoperative complications and shorter hospital stay.
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