Rehabilitation Starting on the Day of Cardiac Surgery

Our current rehabilitation program starts 2 hours after cardiac surgery. To confirm the safety and usefulness of the program, retrospective study was conducted.

Inclusion Criteria for the program are as follows: 1. Elective surgery; CABG, valve surgery, and their combination, 2. Well-awake without ventilation; 2 hours after operation, 3. No femoral lines such as IABP or arterial lines, 4. Chest tube drainage less than 100ml/h, and 5. No neurological, hemodynamic, or subjective abnormalities. Withdrawal criteria are 1. Subjective symptoms, 2. ECG changes or arrhythmia, 3. Changes in vital signs, and 4. Difficulty in standing position.

Among 546 patients who underwent elective cardiac surgery between 2013 and 2016, 365 patients matched the criteria (G-0). The other 181 unmatched patients started post-operative rehabilitation on the next day (G-1).There was no adverse event due to rehabilitation during the study period.

There were significant differences between the 2 groups in age (71.0 vs 73.4 years), Barthel Index (97.6 vs 96.1) or Mini-Mental State Examination (26.7 vs 25.1), grip power (27.4 vs 24.9 kgf), 6-min walk (333 vs 311 m) and Japan risk score (2.9 vs 4.7), pre-operatively. Operation time was shorter in G-0 (269 vs 331 min). Seventy-six % of G-0 patients went home directly, while 57% of G-1 did (P<0.001). Homer-Lemshow test showed that post-operative stay (median 11 days) was affected by length of ICU stay, walking distance on POD3, pre-operative FEV1% and post-operative depression (P=0.842, predictive accuracy =78.3%).

Those data suggested that the patients with lower risks started rehabilitation on the day of cardiac surgery and that the program may facilitate the patients with higher risks starting rehabilitation earlier by changing the inclusion and withdrawal criteria.