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Effect of a Preoperative Intervention on Preoperative and Postoperative Outcomes in Low-Risk Patients Awaiting Elective Coronary Artery Bypass Graft Surgery: A Randomized, Controlled Trial

Heather M. Arthur, PhD; Charlotte Daniels, MSc(T); Robert McKelvie, MD, PhD; Jack Hirsh, MD; and Bonnie Rush
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Copyright ©2004 by the American College of Physicians

Ann Intern Med. 2000;133(4):253-262. doi:10.7326/0003-4819-133-4-200008150-00007
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Background: In publicly funded health care systems, a waiting period for such services as coronary artery bypass graft surgery (CABG) is common. The possibility of using the waiting period to improve patient outcomes should be investigated.

Objective: To examine the effect of a multidimensional preoperative intervention on presurgery and postsurgery outcomes in low-risk patients awaiting elective CABG.

Design: Randomized, controlled trial.

Setting: A regional cardiovascular surgery center in a tertiary care hospital, southwestern Ontario, Canada.

Patients: 249 patients on a waiting list for elective CABG whose surgeries were scheduled for a minimum of 10 weeks from the time of study recruitment.

Intervention: During the waiting period, the treatment group received exercise training twice per week, education and reinforcement, and monthly nurse-initiated telephone calls. After surgery, participation in a cardiac rehabilitation program was offered to all patients.

Measurements: Postoperative length of stay was the primary outcome. Secondary outcomes were exercise performance, general health-related quality of life, social support, anxiety, and utilization of health care services.

Results: Length of stay differed significantly between groups. Patients who received the preoperative intervention spent 1 less day [95% CI, 0.0 to 1.0 day] in the hospital overall (P = 0.002) and less time in the intensive care unit (median, 2.1 hours [CI, −1.2 to 16 hours]; P = 0.001). During the waiting period, patients in the intervention group had a better quality of life than controls. Improved quality of life continued up to 6 months after surgery. Mortality rates did not differ.

Conclusion: The waiting period for elective procedures, such as CABG, may be used to enhance in-hospital and early-phase recovery, improving patients' functional abilities and quality of life while reducing their hospital stay.


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Figure 1.
Flow of patients through the trial.

* Change in elective status. † Men only. CABG = coronary artery bypass graft surgery; T2 = 1 week before surgery; T3 = 6 to 8 weeks after surgery; T4 = 6 months after surgery.

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Figure 2.
Change in health-related quality of life over time.

Solid lines indicate the treatment group; dotted lines indicate the control group. * Significant main effect for time (baseline to 6 months after surgery): = 8.49; < 0.001. † Significant group-by-time interaction (baseline to 1 week before surgery): = 8.47; = 0.004. ‡ Significant main effect for group (baseline to 6 months after surgery): = 8.63; = 0.0038. § Significant main effect for time (1 week before surgery to 6 months after surgery): = 120.6; < 0.001. SF-36 = Medical Outcomes Study 36-item Short Form Survey.

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