The Rehabilitation in Cardiosurgical Patients: Hospital Length of Stay, Considerations of its Reduction

Elina Vlasova, Larisa Ilyina, Said Kurbanov, Renat Akchurin, Andrey Shiryaev, Vladislav Vasiliev, Damir Galyautdinov, Ruslan Latipov, Sergey Korolev

National medical research center for cardiology, Moscow, Russia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – B

Abstract

The purpose: to find out is there any hidden reserves of in-hospital rehabilitation optimization

Materials, methods.The postoperative length of stay (PLOS) in 1021 patients underwent on-pump cardiac surgery on 2015 January – 2017 December was analyzed.

Results. Fast rehabilitation (PLOS≤8 days) was possible in 16% of cases. The group was formed by middle-aged patients underwent predominantly isolated coronary bypass surgery; the proportion of diabetes mellitus (DM) patients was 17%; the percentage of persons over 75 years old was 5%. Most patients (46%) were discharged on days 9-11. In this group: 9% of pts had combined surgery, 3% had initial chronic heart failure (CHF) and postoperative low cardiac output syndrome (LCOS), 7% had coronary endarterectomy, 9% were older than 75 years, 26% had DM, requiring therapy.

Atrial fibrillation, hypoventilation/lung atelectasis, encephalopathy did not delay rehabilitation; the incidence of long-term wound infections has decreased to minimum. The following factors contributed to the prolongation of recovery: a) LCOS in patients with initial CHF (3%) and b) slow activation in aged patients (6%); there is hardly any advance expected In these cases. However, a significant part of "long PLOS" group consisted of patients been activated in standard terms, but been discharged with a delay of 4-5 days due to a warfarin or hypoglycemic medicine dose selection (7 and 19% resp.) as well as due to lack of appropriate health care at the patient residence place (9%). This patients should be considered as a cohort of early rehabilitation outside the cardiosurgical department.

Conclusion. Half of the on-pump operated patients are discharged on the 9-11th day. At least a third of them can be transferred to a rehabilitation department 4-5 lays earlier; it will increase the efficiency of the cardiovascular unit.