Effect of a Preoperative Intervention on Preoperative and Postoperative Outcomes in Low-Risk Patients Awaiting Elective Coronary Artery Bypass Graft Surgery

Effect of a Preoperative Intervention on Preoperative and Postoperative Outcomes in Low-Risk Patients Awaiting Elective Coronary Artery Bypass Graft Surgery

A Randomized, Controlled Trial

From McMaster University and Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada.

Abstract

Background: In publicly funded health care systems, a waiting period for such services as coronary artery bypass graft surgery (CABG) is common. The possibility of using the waiting period to improve patient outcomes should be investigated.

Objective: To examine the effect of a multidimensional preoperative intervention on presurgery and postsurgery outcomes in low-risk patients awaiting elective CABG.

Design: Randomized, controlled trial.

Setting: A regional cardiovascular surgery center in a tertiary care hospital, southwestern Ontario, Canada.

Patients: 249 patients on a waiting list for elective CABG whose surgeries were scheduled for a minimum of 10 weeks from the time of study recruitment.

Intervention: During the waiting period, the treatment group received exercise training twice per week, education and reinforcement, and monthly nurse-initiated telephone calls. After surgery, participation in a cardiac rehabilitation program was offered to all patients.

Measurements: Postoperative length of stay was the primary outcome. Secondary outcomes were exercise performance, general health-related quality of life, social support, anxiety, and utilization of health care services.

Results: Length of stay differed significantly between groups. Patients who received the preoperative intervention spent 1 less day [95% CI, 0.0 to 1.0 day] in the hospital overall (P = 0.002) and less time in the intensive care unit (median, 2.1 hours [CI, −1.2 to 16 hours]; P = 0.001). During the waiting period, patients in the intervention group had a better quality of life than controls. Improved quality of life continued up to 6 months after surgery. Mortality rates did not differ.

Conclusion: The waiting period for elective procedures, such as CABG, may be used to enhance in-hospital and early-phase recovery, improving patients' functional abilities and quality of life while reducing their hospital stay.

Article and Author Information

Acknowledgments: The authors thank the staff of the Cardiac Health and Rehabilitation Center at the Hamilton Health Sciences Corporation General Campus for their enthusiastic participation in this project and Lee Wilson for preparing the manuscript. They also thank the following cardiovascular surgeons, who referred patients to the study: Dr. W. Shragge, Dr. K. Teoh, Dr. A. Parisi, Dr. J. Gunstensen, Dr. I. Cybulski, Dr. S. Brister, and Dr. A. Lamy.
Grant Support: By the Heart and Stroke Foundation of Ontario (#NA 2808).
Requests for Single Reprints: Heather M. Arthur, PhD, McMaster University, Faculty of Health Sciences, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada; e-mail, arthurh{at}fhs.mcmaster.ca.
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Current Author Addresses: Drs. Arthur, McKelvie, and Hirsh: McMaster University, Faculty of Health Sciences, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada.
Ms. Daniels: Cardiac and Vascular Program, Hamilton Health Sciences Corporation, General Division, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.
Ms. Rush: Supportive Cancer Care Research Unit, Hamilton Health Sciences Corporation, Henderson Division, 699 Concession Street, Hamilton, ON L8V 1C3, Canada.
Author Contributions: Conception and design: H.M. Arthur, C. Daniels, R. McKelvie, J. Hirsh.
Analysis and interpretation of the data: H.M. Arthur, C. Daniels, R. McKelvie, B. Rush.
Drafting of the article: H.M. Arthur, R. McKelvie.
Critical revision of the article for important intellectual content: H.M. Arthur, C. Daniels, R. McKelvie, J. Hirsh, B. Rush.
Final approval of the article: H.M. Arthur, C. Daniels, R. McKelvie, J. Hirsh.
Provision of study materials or patients: R. McKelvie.
Obtaining of funding: H.M. Arthur, R. McKelvie, J. Hirsh.
Administrative, technical, or logistic support: C. Daniels, B. Rush.
Collection and assembly of data: B. Rush.