Factors Determining the Functional State of Cardiac Surgery Patients with Complicated Postoperative Period

Abstract

The purpose of this work was to study the factors determining the functional state of cardiac surgery patients with a complicated postoperative period upon discharge from the hospital. This observational study included 60 patients who underwent cardiac surgery with a complicated postoperative course and with a prolonged intensive care unit stay of more than 72 h. We assessed handgrip and lower-extremity muscle strength and the six-minute walk test (6MWT) distance 3 days after the surgery and at discharge from the hospital. Some patients (53%) additionally underwent a course of neuromuscular electrostimulation (NMES). Two groups of patients were formed: first (6MWT distance at discharge of more than 300 m) and second groups (6MWT distance of 300 m or less). The patients of the second group had less lower-extremity muscle strength and handgrip strength on the third postoperative day, a longer aortic clamping time and a longer stay in the intensive care unit. Independent predictors of decreased exercise tolerance at discharge were body mass index, foot extensor strength and baseline 6MWT distance in the general group, duration of cardiopulmonary bypass in the NMES group and in the general group, and age in the NMES group. Thus, the muscle status on the third postoperative day was one of the independent factors associated with the 6MWT distance at discharge in the general group, but not in patients who received NMES. It is advisable to use these results in patients with complications after cardiac surgery with the use of NMES rehabilitation.

Relationship between Perme ICU Mobility Score and length of stay in patients after cardiac surgery

“…In our study, the median CBPT was 94 minutes. Similar to our results, in a recent observational study that included 60 patients who underwent cardiac surgery, Sumin et al demonstrated that CBPT was an independent predictor of functional state in patients with a complicated postoperative period upon discharge from the hospital 56 .…”

A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery

“…There were no significant differences between the groups in postoperative outcomes (Table 4). The choice of the primary outcome of change in preoperative 6MWT from baseline was made after consultation with patients; reduced 6MWT is associated with moderate or severe complications after both noncardiac [15] and cardiac surgery [16]; conversely, improved 6MWT has been validated as an indicator of recovery in patients undergoing cardiac surgery [12,14,17]. Although a significant improvement in pre-operative exercise capacity was not observed in the prehabilitation cohort over standard care, it was observed in patients exhibiting sarcopenia measured by handgrip strength, which represented over a quarter of the trial population.…”

Utility of Cardiac Rehabilitation for Long-Term Outcomes in Patients with Hospital-Acquired Functional Decline after Cardiac Surgery: A Retrospective Study

“…This study was conducted at the cardiovascular center, which is one of the largest CR centers in Japan [ 12 ], and phases I and II provide seamless CR. Phase II CR is based on established evidence, and in recent years, phase I CR has been advocated, including early postoperative mobilization and neuromuscular electrical stimulation, which is an important treatment strategy for improving short- and long-term prognoses [ 24 , 25 , 26 , 27 ]. Therefore, phase I and II CR are necessary to prevent hospital-acquired functional decline and MACE.…”