Controversies in patient management after cardiac surgery

Abstract

The cardiovascular surgical patient presents great challenges in terms of patient management. As the specialty has grown since its earlier days, so have the strategies for patient management and related nursing practice. This article examines four controversial topics related to postoperative management of these patients: treatment for atrial fibrillation, antithrombotic therapy, replacement fluid management, and issues related to advanced nursing practice. Three of these topics, although having a medical focus, augment the nursing knowledgebase and provide assistance in independent decision making. The fourth topic reviews issues related to extended practice within the staff nurse role.

Atrial Fibrillation Following Cardiac Surgery: A Retrospective Cohort Series

“…Postoperative AF usually does not result in long‐term sequelae, but places patients at high risk for life‐threatening complications such as ventricular arrhythmias, hemodynamic compromise, thromboembolism, severe gastrointestinal complications, and stroke 3,4,6,9–11,17,23,24,27–30 and has been associated with prolonged recovery time and increased length of hospital stay, readmission to the intensive care unit, and health care expenditure 3,4,8–10,12,14,23,25,31 . Hospital stay is generally increased by a minimum of 2–3 days, with a recent study attributing an additional 4 days with a significant increase in hospital costs ($7500 per patient) to postoperative AF 32 …”

“…Atrial fibrillation (AF) is one of the most common postoperative complications of cardiac surgery 1–13 . The incidence of postoperative AF has been reported to be approximately 40% after coronary artery bypass graft (CABG) surgery, 2,4–8,11,14–21 40%–80% after cardiac valve surgery, 4,6,17 and as high as 90% following combined CABG and cardiac valve surgery 4,6 . While AF may occur at any time up to 3 weeks postoperatively, it generally occurs within the first 5 days, with the peak incidence occurring on the second to fourth day after surgery 4–6,9,11,22–24 .…”