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Published on: March 27, 2018
Impact of Early Ambulation on the Prognosis of Coronary Artery Bypass Grafting Patients
Yohei Tsuchikawa1, Yoshiyuki Tokuda2, Hideki Ito2
1Department of Rehabilitation, Nagoya University Hospital.
Insights
Delayed ambulation after coronary artery bypass grafting (CABG) is linked to poor patient outcomes. Early mobilization within 3 days is recommended to reduce complications and improve long-term survival.
Area of Science:
- Cardiovascular Surgery
- Postoperative Care
- Patient Outcomes
Background:
- The impact of delayed patient mobilization on outcomes following coronary artery bypass grafting (CABG) requires further investigation.
- Early ambulation protocols are standard recommendations post-cardiac surgery, but their specific benefits require continued evaluation.
Purpose of the Study:
- To evaluate the association between the timing of first ambulation and both in-hospital and long-term outcomes in patients undergoing isolated coronary artery bypass grafting (CABG).
Main Methods:
- A retrospective analysis of 887 patients who underwent isolated CABG, focusing on the timing of their first ambulation post-operation.
- Multivariable logistic regression and Cox hazards analysis were used to identify factors associated with delayed ambulation and its impact on adverse events.
Main Results:
- Delayed ambulation (≥4 days) was associated with increased postoperative complications like pneumonia and stroke.
- Delayed ambulation significantly correlated with higher rates of major adverse cardiac events and mortality during a median 60-month follow-up.
- Each day of delayed ambulation increased the risk of long-term adverse events.
Conclusions:
- Delayed ambulation in isolated CABG patients is linked to adverse in-hospital and long-term outcomes.
- These findings reinforce the importance of adhering to early ambulation protocols after cardiac surgery to improve patient recovery and survival.
Background:
The effect of delayed ambulation on the outcome of coronary artery bypass grafting (CABG) remains to be clarified.
Methods And Results:
The long-term and in-hospital outcomes of 887 patients who underwent isolated CABG (455 off-pump cases, 135 urgent cases) were evaluated, with a focus on the timing of first ambulation. In-hospital mortality cases were excluded. Early ambulation (first ambulation within 3 days after operation) was achieved in 339 (38%) patients. In the multivariable logistic regression analysis, longer operation time and urgent case, EuroSCORE II, re-thoracotomy, and respiratory time were associated with delayed (≥4 days) ambulation. Delayed ambulation was associated with a high incidence of postoperative complications, such as pneumonia, and stroke (P<0.01). Following discharge, 22.2% of patients experienced major cardiac events and 13.8% died during the follow-up period (median follow-up 60 months). Cox hazards analysis revealed that delayed ambulation was associated with long-term adverse events (hazard ratio 1.04 per day, P<0.001). With adjustment for preoperative factors, the estimated future risk of adverse events was found to be increased day-by-day during the delay until initial ambulation.
Conclusions:
In isolated CABG patients, delayed ambulation was associated with poor outcomes, even in the long-term period. The results support the current guideline recommending early ambulation protocol after cardiac surgery.
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