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

Background: In publicly funded health care systems, a waiting period for su ch services as coronary artery bypass graft surgery (CABG) is common. The p ossibility of using the waiting period to improve patient outcomes should b e investigated. Objective: To examine the effect of a multidimensional preoperative interve ntion 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 hospit al, 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 exerc ise training twice per week, education and reinforcement, and monthly nurse -initiated telephone calls. After surgery, participation in a cardiac rehab ilitation program was offered to all patients. Measurements: Postoperative length of stay was the primary outcome, seconda ry outcomes were exercise performance, general health-related quality of li fe, 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) acid 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 afte r surgery. Mortality rates did not differ. Conclusion: The waiting period for elective procedures, such as CABG, may b e used to enhance in-hospital and early-phase recovery, improving patients' functional abilities and quality of life while reducing their hospital sta y.