Comparison of post-operative pain, stress response, and quality of life inport access vs. standard sternotomy coronary bypass patients

Objective: Although it has been postulated that minimally invasive cardiac surgery using the port access method would reduce operative stress and post operative pain and accelerate postoperative recovery to a good quality of l ife, few data are currently available to document this intuitively appealin g claim. Therefore, this study was designed to examine differences in stres s response, postoperative pain. rapidity of recovery, and quality of life a fter port access (PA) isolated coronary artery bypass surgery compared with standard sternotomy (STD) isolated coronary bypass surgery, Methods: Fourt een PA and 15 STD coronary bypass patients were studied postoperatively for pain score, FEV, catecholamine and cortisol levels, resumption of activity , and Duke Activity Scale ratings. The surgical approach was based on the s urgeon's preference. Although the PA patients were younger, there were no o ther differences between the groups in gender or preoperative risk factors. Results: There were no operative deaths and no differences between the gro ups in perioperative complications. Repeated measures analysis of variance showed lower pain scale ratings over the first 4 postoperative weeks in the PA group (P < 0.001). The PA patients also had less muscle soreness, short ness of breath, fatigue, and poor appetite at 1, 2, 4, and 8 weeks (P < 0.0 5), better FEV at 1 day (1.59 vs. 0.97 Vs; P < 0.02) and 3 days (2.20 vs. 1 .49 1/s; P < 0.03), and lower norepinephrine levels at days 1,2, and 3 (P = 0.005). The Duke Activity Scale questionnaire results demonstrated that mo n PA patients were able to walk 1-2 blocks at 1 week, climb stairs at 1 and 2 weeks, perform light or moderate housework at 1 and 2 weeks, and engage in moderate recreational activities and perform heavy housework at 4 and 8 weeks (P < 0.05). Conclusions: These results show that compared with STD co ronary bypass patients PA patients enjoyed significant postoperative physio logic and quality of life advantages with less pain, less early stress resp onse, better pulmonary function, and superior Duke Activity scores during t he first 2 postoperative months. (C) 1999 Elsevier Science B.V. All rights reserved.