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Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery

100%

Salehiomran A., Ahmadi H., Karimi A., Tazik M., Dowlatshahi S., Fathollahi M., Abbasi S.

Open Medicine

2009

vol. 4

issue 3

286-292

Transfusion after cardiac surgery is very common. This rate varies between institutions and has remained high despite established transfusion guidelines. We analyzed our database of patients who underwent isolated CABG (Coronary Artery Bypass Graft) to determine the predictive factors of homologous transfusion and associated postoperative morbidity, mortality and resource utilization. All 14,152 patients who underwent first-time isolated CABG, with or without cardiopulmonary bypass (CPB) who had postoperative homologous transfusion between February 2002 and March 2008 in Tehran Heart Center, were evaluated retrospectively. Overall, 16.5% of patients received transfusion. Transfused patients demonstrated a significantly higher incidence of postoperative complications (cardiac, infectious, ischemic, reoperation) and mortality (p<0.001). Homologous blood transfusion effect on mortality, morbidity and resource utilization. By Multivariable logistic regression analysis adjusted for confounders: Homologous blood transfusion effect on Mortality (30-days) (OR=3.976, p<0.0001), Prolonged ventilation hours (OR=4.755, p<0.0001), Total ICU hours (β =14.599, p<0.0001), Hospital length of stay (β =1.141, p<0.0001), Post surgery length of stay (β =0.955, p<0.0001). We conclude that the isolated CABG patients receiving blood transfusion have significantly higher mortality, morbidity and resource utilization. Homologous blood transfusion is an independent factor of increased resource utilization, morbidity and mortality.

Selected trials of the Senior Fitness Test as a measure of the functional ability of patients given early post-hospital rehabilitation following a coronary artery bypass grafting

71%

Pabisiak A., Adamczyk A.

Medical Rehabilitation

2014

vol. 18(2)

11-16

Wstęp: Spodziewanym efektem usprawniania po pomostowaniu aortalno-wieńcowym (CABG) jest odbudowanie sprawności funkcjonalnej chorych, jednak brak metody oceny czynnościowej określającej stan zarówno bezpośrednio po zabiegu jak i po zastosowanej rehabilitacji uniemożliwia dokładne oszacowanie uzyskanych korzyści. Celem niniejszej pracy była próba wykorzystania wybranych prób Senior Fitness Test do oceny sprawności funkcjonalnej pacjentów poddanych CABG po odbyciu wczesnego etapu rehabilitacji kardiologicznej w warunkach sanatoryjnych, jako miary efektów usprawniania. Projekt badawczy: Badanie przed-po Materiał i metody: Trzydziestu mężczyzn w wieku od 60 do 78 roku życia (średnia 68,6 ±6,2 lat) po CABG odbywających wczesną rehabilitację kardiologiczną w szpitalu uzdrowiskowym (turnus 21 dni) poddano dwuetapowym badaniom. Pierwsze badanie zostało przeprowadzone w pierwszych dniach pobytu (średnio 18 dni od operacji) a drugie (średnio 39 dni od operacji) w ostatnich dniach pobytu pacjentów w szpitalu uzdrowiskowym. W obu badaniach zastosowano wybrane próby Senior Fitness Test: siły dolnej części ciała, ocenę koordynacji złożonej i próbę 2-minutowego marszu w miejscu. Wyniki: Po 21 dniach obserwacji pacjenci istotnie poprawili wynik próby siły dolnej części ciała (p<0,001), próbę koordynacji złożonej (p<0,001) i próbę marszu 2-minutowego w miejscu (p<0,001). Dodatkowo zaobserwowano istotne obniżenie poziomu tętna, ciśnienia skurczowego i ciśnienia rozkurczowego przed i po marszu 2-minutowym w miejscu. Wnioski: Pacjenci po CABG po odbyciu terapii we wczesnym okresie poszpitalnym istotnie poprawili sprawność funkcjonalną, a zastosowanie wybranych prób Senior Fitness Test wskazuje na możliwość przeprowadzenia oceny sprawności funkcjonalnej w tej grupie chorych jako miary efektów terapii.

Introduction: The expected effect of rehabilitation after coronary artery bypass grafting (CABG) is the restoration of the patients’ functional fitness. However, the absence of a method for a functional assessment of the patients’ condition both immediately after the procedure and after rehabilitation makes it impossible to precisely evaluate patients’ improvement. The aim of the present study is an attempt to use selected items of the Senior Fitness Test to evaluate the functional fitness of patients who have undergone CABG after an early stage of cardiac rehabilitation in sanatorium conditions as a measure of the effects of rehabilitation.Research project: Before/after testingMaterial and methods: Thirty men aged 60 to 78 (mean age 68.6 ±6.2 years) undertaking early cardiac rehabilitation in a spa hospital (a 21-day stay) after CABG were subject to two-stage testing. The first set of tests was conducted at the beginning of their stay (on average 18 days after the surgery), and the second set was conducted during the last days of their stay at the spa hospital (on average 39 days after the surgery). In both sets of tests, the following items of the Senior Fitness Test were applied: the lower body strength test, the complex coordination test, and the 2-minute Step-in-Place test.Results: After 21 days of observation, the patients significantly improved their results in the lower body strength test (p<0.001), the complex coordination test (p<0.001) and the 2-minute Step-in-Place test (p<0.001). Additionally, a significant decrease in heart rate and systolic and diastolic blood pressure before and after the 2-minute Step-in-Place test was observed.Conclusions: Post-CABG patients, having undergone therapy at an early post-hospital stage, significantly improved their functional fitness. The application of the selected Fullerton Test items showed the possibility of using a functional fitness evaluation in this group of patients as a measure of the effects of the therapy.

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Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery

Selected trials of the Senior Fitness Test as a measure of the functional ability of patients given early post-hospital rehabilitation following a coronary artery bypass grafting