Early mobilization reduces delirium after coronary artery bypass graft surgery

Abstract

Background Postoperative delirium is common in patients undergoing coronary artery bypass grafting, characterized by cognitive decline. This study aimed to evaluate the effect of early planned mobilization on delirium after coronary artery bypass grafting. Methods This double-blind randomized clinical trial enrolled 92 consecutive patients who underwent coronary artery bypass grafting from September to December 2018. The patients were divided into two groups of 46: a mobilization protocol was applied in the intervention group in the first 2 days after surgery; the control group received routine nursing care only. Demographic data, medical records, and Neecham confusion scores were analyzed. Results Patients in the control group used cigarettes (31.1% vs. 11.1%, p = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, p = 0.002) more frequently, had longer intubation times (11.91 ± 3.87 vs. 10.23 ± 2.71 h, p = 0.020), and fewer blood components infused (15.6% vs. 33.3%, p = 0.05). More patients in the intervention group had normal function on the 2nd postoperative day compared to the control group (25 vs. 2, respectively, p = 0.001). The intervention group had significantly higher Neecham scores on postoperative day 2 (22.49 ± 2.03 vs. 26.82 ± 2.10, p = 0.001). Multivariable analysis showed significant associations between Neecham score and age ( p = 0.022), ejection fraction ( p = 0.015), myocardial infarction ( p = 0.016), systolic pressure ( p = 0.009), and diastolic pressure ( p = 0.008). Conclusions Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.

Benefits of Early in Postoperative Cardiac Surgery Patients

“…The multivariate analysis showed significant associations between the Neecham score and age (p = 0.022), ejection fraction (p = 0.015), myocardial infarction (p = 0.016), systolic pressure (p = 0.009) and diastolic pressure (p = 0.008). It is concluded that early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass graft [4].…”

“…It was interesting to observe that the higher TCEC (already previously described) was a limiting factor for the delay of EM [2]. Another study published in 2020 by Shirvani F, was a randomized, double-blind clinical trial, which concluded that early planned mobilization was effective in reducing delirium in postoperative patients undergoing coronary artery bypass graft [4]. The objective of this systematic review is to analyze the evidence for the benefits of early mobilization in patients after cardiac surgery.…”

Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

“…Significant emphasis is placed on early mobilisation and physiotherapy involvement post-surgery, and rightfully so. It has been well established that early ambulation, especially in high risks patient reduces postoperative complications and LOS [193][194][195][196]. A 23 h protocol for laparoscopic nephrectomy was developed in the early 2000s involving ambulation on the day of surgery itself; it was safe and effective [197][198][199].…”

Determining Factors for Independent Walking in Patients Undergoing Cardiovascular Surgery: Differences between Coronary Artery Bypass Grafting, Heart Valve Surgery, and Aortic Surgery

“…It is recommended that cardiac rehabilitation (CR) after cardiovascular surgery should be started in the early post-operative period, within 24-72 h after surgery [1][2][3]. Early CR is effective in reducing post-operative complications, in improving exercise tolerance, and in preventing delirium [1,[4][5][6][7][8]. In addition, independent walking is targeted to be achieved within 4-7 days after surgery, and continued exercise training, mainly aerobic exercise such as walking, is effective in reducing rehospitalization and coronary risk factors and in enhancing quality of life [1,[9][10][11][12][13][14][15].…”

“…The current limitation in the literature is that studies examining the factors that determine independent walking are limited to the type of surgery. Increased knowledge of the determinants of independent walking may be useful for appropriate post-operative CR and resource management, and early independent walking may contribute to shorter hospital stays and lower medical costs [4][5][6][7][8]. Therefore, the aims of this study were (1) to investigate the characteristics of delayed achievement of independent walking after different types of cardiovascular surgery and (2) to evaluate the CR progression in different surgical techniques.…”