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Crit Care Nurse. 2014 Dec;34(6):29-36. doi: 10.4037/ccn2014951.

Improving patients' readiness for coronary artery bypass graft surgery.

Author information

1
Kristine Chaisson is administrative director for cardiovascular services at Concord Hospital in Concord, New Hampshire.Mary Sanford is a nurse practitioner-clinician at Catholic Medical Center in Manchester, New Hampshire.Richard A. Boss Jr is a cardiologist at Concord Hospital.Bruce J. Leavitt is a cardiac surgeon and a professor of cardiothoracic surgery at Fletcher Allen Health Care in Burlington, Vermont.Michael J. Hearne is a retired interventional cardiologist in New Boston, New Hampshire.Cathy S. Ross is administrative director/research associate at the Northern New England Cardiovascular Disease Study Group, Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire.Elaine M. Olmstead is a senior analyst in cardiac surgery at the Northern New England Cardiovascular Disease Study Group, Geisel School of Medicine at Dartmouth College.Robert S. Kramer is director of research in the Division of Cardiothoracic Surgery at Maine Medical Center in Portland.Patricia Hofmaster is a data manager at Eastern Maine Medical Center in Bangor.Cathy Mingo is a quality project coordinator at Eastern Maine Medical Center.Dennis Duquette is a cardiovascular data analyst at Portsmouth Regional Hospital in Portsmouth, New Hampshire.Elizabeth Maislen is an instructor in surgery at Geisel School of Medicine at Dartmouth College and Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.Jean A. Clark is a retired nurse practitioner at Dartmouth-Hitchcock Medical Center.Donald S. Likosky is the former cardiac surgery research director of the Northern New England Cardiovascular Disease Study Group and an associate professor of cardiac surgery at University of Michigan Medical School in Ann Arbor.Susan R. Horton is executive director of the Central Maine Heart and Vascular Institute, Central Maine Medical Center in Lewiston.Gerald T. O'Connor is a retired professor of medicine and former director of the Northern New England Cardiovascular Disease Study Group at Geise

Erratum in

Abstract

BACKGROUND:

Preoperative interventions improve outcomes for patients after coronary artery bypass surgery (CABG).

OBJECTIVE:

To reduce mortality for patients undergoing urgent CABG.

METHODS:

Eight centers implemented preoperative aspirin and statin, preinduction heart rate less than 80/min, hematocrit greater than 30%, blood sugar less than 150 mg/dL (8.3 mmol/L), and delayed surgery at least 3 days after a myocardial infarction. Data were collected on the last 150 isolated, urgent CABGs at each center (n=1200). A "bundle" score of 0 to 100 was calculated for each patient to represent the percentage of interventions used.

RESULTS:

Scores ranged from 33 to 100. About 56% of patients had a perfect score. Crude mortality and composite rates were lower in patients with higher scores, but once adjusted for patient and disease characteristics, the difference in scores was not significant. Higher scores were associated with shorter intubation: 6.0 hours (score 100), 8.0 hours (score 80-99), 8.4 hours (score<80) (log-rank P<.001). Median length of stay was shorter for patients with higher scores: 5 days (score 100), 6 days (scores 80-99), and 6 days (scores <80) (log-rank P<.001).

CONCLUSION:

Implementation of interventions to optimize patients' "readiness for surgery" is associated with shorter intubation times and shorter hospital stays after CABG.

PMID:
25452407
DOI:
10.4037/ccn2014951
[Indexed for MEDLINE]
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