Improving Patients’ Readiness for Coronary Artery Bypass Graft Surgery

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.

Effectiveness of a short-term multimodal prehabilitation program in adult patients awaiting selective cardiac surgery: study protocol for an open-label, pilot, randomized controlled trial

“…To date, while studies have mainly focused on postoperative functional performance and recovery (10), there is increasing evidence that preoperative readiness is essential for successful postoperative recovery. In particular, patient readiness for surgery has been associated with shorter mechanical intubation times and reduced length of stay after CABG (24). Preoperative frailty is also an important indicator in preoperative decision-making and can help predict patient recovery trajectory (25).…”

Perioperative Statin Therapy for Patients Undergoing Coronary Artery Bypass Grafting

“…However, significant heterogeneity among studies was noted in both meta-analyses [44,70]. Further, a recently published study showed that a bundle of preoperative interventions, including PST, before urgent CABG improved outcomes, including shorter hospital stays and lesser intubation times [71]. This effect can be explained by the reduction in the rate of postoperative complications as detailed previously.…”

The 30-Year Influence of a Regional Consortium on Quality Improvement in Cardiac Surgery

“…In addition, with advances in perioperative management, we have shifted quality improvement efforts to best practices in the areas of perioperative readiness for surgery, reduction of PRBC transfusion, and development of prediction models for low-output heart failure. 21,22 We have maintained momentum for the NNECDSG by continuously evolving our quality improvement initiatives, data collection methods, and surgeon-specific quality reports.…”