Predictors of Functional Decline in Activities of Daily Living at Discharge in Patients After Cardiovascular Surgery

Honda, Yasuhiro; Takahashi, Keiko; Sasanuma, Naoki; Itani, Yusuke; Nagase, Masahiro; Uchiyama, Yuki; Tamaki, Akira; Sakaguchi, Taichi; Domen, Kazuhisa

doi:10.1253/circj.cj-20-0909

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…These findings are consistent with the national registry of Korea, which showed that 49% of patients were physically inactive after heart valve surgery [ 9 ], with 39% only becoming inactive after surgery. Japanese researchers found that 18% of patients undergoing cardiovascular surgery experienced a decrease in the activity of daily living (ADL) score at discharge [ 12 ]. Three months after surgery, a functional decrease in ADL was observed in 45% of patients aged 65–79 years and in 56% aged 80 years and older.…”

Section: Discussionmentioning

confidence: 99%

“…When assessing preoperative factors determining postoperative functional status in older age groups, it was shown that low baseline gait speed and cognitive impairment were predictors of a decrease in ADL after surgery [ 12 ]. In a study by Radi B. et al, the distance of 6MWT at discharge after CABG was 314 ± 76 m, and that after valvular surgery was 328 ± 71 m. The 6MWT distance was significantly associated with gender, age, diabetic status, height and presence of atrial fibrillation in patients after CABG and with gender, age and atrial fibrillation in patients undergoing valve surgery [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, recent meta-analyses have obtained conflicting data: early mobilization improved exercise tolerance in patients after cardiac surgery in the work by Kanejima Y et al [ 10 ] but had no effect on the length of stay in the intensive care unit or the total length of hospital stay in a study by Chen and colleagues [ 11 ]. This indicates the continuing relevance of research in this area [ 12 , 13 ], especially in the case of difficulties with the implementation of generally accepted rehabilitation programs. Accordingly, the purpose of this work was to study factors associated with the distance reached during the six-minute walk test by cardiac surgery patients with a complicated postoperative period upon discharge from the hospital.…”

Section: Introductionmentioning

confidence: 99%

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

Sumin

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Безденежных

et al. 2022

IJERPH

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Sumin

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et al. 2022

IJERPH

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“…HAD was defined as a score of ≤5 (requiring monitoring and preparation by a caregiver) on any one of the FIM subitems at discharge compared to preoperatively 21) .…”

Section: Methodsmentioning

confidence: 99%

Association between Hospital-acquired Disability and Clinical Outcomes in Older Patients Who Underwent Cardiac Surgery

SUGIURA,

TAKAHASHI,

SAKATA

et al. 2023

Phys Ther Res

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Objective: This study aimed to clarify the association between hospital-acquired disability (HAD) and prognosis in older patients who underwent cardiac surgery. Methods: This single-center, retrospective, observational study included 141 patients aged ≥65 years who underwent cardiac surgery at our hospital from November 2016 to August 2021. The primary endpoint of this study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs) within 2 years of hospital discharge. HAD was defined as a score of ≤5 on any one of the functional independence measure (FIM) subitems at discharge compared to preoperatively. Results: MACCE was observed in 16.3%, and the incidence of MACCE was significantly higher in the HAD group than that in the non-HAD group (12.1 vs. 34.5%, log-rank, p = 0.003). HAD was also significantly associated with the MACCE (hazard ratio [HD]: 2.575, 95% confidence interval [CI]: 1.001–9.655, p = 0.046). The incidence rate of HAD was 20.6%, with age (odds ratio [OR]: 1.260, 95% CI: 1.080–1.470, p = 0.004), preoperative short physical performance battery (SPPB) score (OR: 0.462, 95% CI: 0.301–0.708, p <0.001), and postoperative delirium (OR: 6.660, 95% CI: 1.480–30.000, p = 0.014) identified as significant factors. Conclusion: HAD is an independent predictor of MACCE in older patients who underwent cardiac surgery.

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“…In addition to physical functions, such as muscle strength, various functional components, including dexterity and cognitive function, are associated with basic ADL [30]; however, these functional assessments were not performed in this study.…”

Section: Limitationsmentioning

confidence: 99%

Physical function examination at intensive care unit as predictive indicators for hospitalization-associated disability in patients after cardiovascular surgery

Hirakawa

Nakayama

Saitoh³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Following cardiovascular surgery, patients are at high risk of requiring systemic management in the intensive care unit (ICU), resulting in hospitalization-associated disability (HAD). Predicting the risk of HAD during the postoperative course is important to prevent susceptibility to cardiovascular events. Assessment of physical function during the ICU stay may be useful as a prediction index but has not been established. Methods: This prospective observational study conducted at a high-volume cardiovascular center included 236 patients (34% female; median age, 73 years) who required an ICU stay of at least 72 hours after surgery and underwent postoperative rehabilitation. HAD was defined as a decrease in the discharge Barthel index (BI) score of at least 5 points relative to the preadmission BI score. Physical Function ICU Test-scored (PFIT-s), Functional Status Score for the ICU (FSS-ICU), and Medical Research Council (MRC)-sumscore were used to assess physical function at ICU discharge. Results: HAD occurred in 58 (24.6%) of the 236 patients following cardiovascular surgery. The cut-off points for HAD were 7.5 points for the PFIT-s (sensitivity 0.80, specificity 0.59), 24.5 points for the FSS-ICU (sensitivity 0.57, specificity 0.66), and 59.5 points for the MRC-sumscore (sensitivity 0.93, specificity 0.66). Multivariate logistic regression analysis revealed a PFIT-s of >7.5 points (odds ratio [OR], 4.84; 95% CI, 2.39-9.80; p < 0.001) and an MRC-sumscore of >59.5 points (OR, 2.43; 95% CI, 1.22-4.87; p = 0.012) as independent associated factors. Conclusions: We demonstrate that the PFIT-s and MRC-sumscore at ICU discharge may be helpful as a predictive indicator for HAD in patients having undergone major cardiovascular surgery.

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Predictors of Functional Decline in Activities of Daily Living at Discharge in Patients After Cardiovascular Surgery

Cited by 8 publications

References 37 publications

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

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

Association between Hospital-acquired Disability and Clinical Outcomes in Older Patients Who Underwent Cardiac Surgery

Physical function examination at intensive care unit as predictive indicators for hospitalization-associated disability in patients after cardiovascular surgery

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