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Ann Intern Med. 2000 Aug 15;133(4):253-62.

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.

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  • 1McMaster University, Faculty of Health Sciences and Hamilton Health Sciences Corporation, Ontario, Canada. arthurh@fhs.mcmaster.ca

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.

PMID:
10929164
[PubMed - indexed for MEDLINE]
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