Effect of a Nurse Practitioner-Led Bundled Care on Postoperative Recovery in Cardiac Surgery Patients: A Randomized...

Postoperative delirium, pain, and sleep disturbances prolong recovery after cardiac surgery. Evidence for multicomponent, nurse practitioner-led interventions is limited, especially in resource-constrained settings. This study evaluated their effect on delirium, pain, sleep quality, and hospital stay. In a single-blinded, post-test only RCT at a tertiary cardiac hospital in India, 100 adults undergoing elective coronary artery bypass graft, mitral valve replacement, or aortic valve replacement were randomized to nurse practitioner-led bundled care (n = 50) or routine care (n = 50). The intervention included preoperative orientation, early mobilization, cognitive reorientation, family engagement, relaxation, and sleep promotion. Outcomes-delirium (CAM-ICU), pain (VAS), and sleep quality (RCSQ) and length of stay were analyzed using chi-square/Fisher's exact tests, repeated-measures ANOVA, GLM, and Mann-Whitney U tests. All 100 participants completed the study (n = 50 per group) with comparable baseline demographics and clinical profiles. The intervention group showed significantly lower postoperative delirium (Day 2: 6% vs. 32%, p = 0.001; GLM group × time interaction p = 0.009), reduced pain scores across Days 1-3 (F_1,98 = 72.18, p < 0.001), and improved sleep quality across Days 2-4 (F_1,98 = 233.35, p < 0.001; group × time interaction p < 0.001) compared with controls. Recovery was faster, with shorter ICU stay (median 3 vs. 3-4 days, p = 0.006), ward stay (5 vs. 6 days, p = 0.002), and total hospital stay (8 vs. 10 days, p < 0.001). Nurse practitioner-led bundled care reduces delirium, improves pain and sleep, and shortens recovery, providing a feasible, low-cost approach for cardiac surgery patients. Trial Registration: CTRI/2023/06/054180 Dated 6/19/2023.