Abstract 13167: Early Mobilization in Postoperative Cardiac Surgical Patients

Abstract

Introduction: Early mobilization (EM) is recommended by cardiac surgical societies. However, the optimal method of EM delivery has yet to be determined. Our objective was to assess whether a bedside nurse-driven EM strategy is safe and associated with improved outcomes following cardiac surgery. Methods: Consecutive post-cardiac surgery patients in a cardiovascular intensive care unit (CVICU) at an academic tertiary care centre from 2017 to 2019 prior to and after EM program implementation were reviewed. Postoperative cardiac surgery patients were initially managed in a general ICU and transferred to the CVICU when hemodynamic stability was achieved, typically postoperative day 1 or 2. Functional status was assessed by the nurse on CVICU admission using the Level of Function (LOF) Mobility Scale, which ranges from LOF 0 (bed immobile) to LOF 5 (walks > 50 feet). The nurse uses the LOF score to guide twice-daily level-specific mobility activities. The primary outcome was hospital length of stay. Results: There were 504 patients included in the study (preintervention, N=329; Intervention, N=175). There was no difference in age, sex or comorbid illness between the groups (Table). The LOF was 4.7 ± 0.5 prior to surgery, 3.4 ± 1.1 on CVICU admission, and 4.3 ± 0.6 on CVICU discharge in patients undergoing EM. Patients were mobilized during nearly all mobilization opportunities (98.7%; 685/694). Adverse events were rare (0.4%; 8 events/1901 mobilization activities), minor and transient. There was no difference is postoperative hospital length of stay, in-hospital mortality, discharge home or 30-day hospital re-admission (all P>0.05). Conclusion: A nurse-driven EM program was safe and associated with improvement in functional status in postoperative cardiac surgery patients. The EM program was not associated with improved short-term outcomes. Further studies are needed to understand optimal delivery of EM in cardiac surgical patients.