Early Physical Rehabilitation in Frail Patients Undergoing Coronary Artery Bypass Surgery

Abstract

To date, there are insufficient data on the concept of exploring rehabilitation potential in older patients with frailty syndrome, while developing strategies to improve outcomes after cardiac surgery and reducing the number of postoperative complications remains a relevant topic. Aim. To assess safety and feasibility of early physical rehabilitation in frail patients undergoing coronary artery bypass grafting (CABG). Material and methods. The study included 49 patients with stable coronary artery disease (CAD) admitted for elective CABG with cardiopulmonary bypass (CPB). Patients were randomized into two groups according to the approach to physical rehabilitation: in the early rehabilitation group (n=22), treadmill workouts were conducted starting from the 7th postoperative day and continued at the second stage of inpatient rehabilitation. Patients in the control group (n=27) had no treadmill training. In the inpatient rehabilitation setting, the incidence and the type of complications were assessed; on the 6th day and 21-23 days after CABG, the results of the cardiopulmonary exercise testing (CPET) were analyzed. Results and discussion. The groups were similar in baseline intraoperative characteristics. Postoperative complications occurred in 18% of patients in the early rehabilitation group and in 48% of patients in the control group (p=0.037). In the group of patients with early rehabilitation, the rate of postoperative complications decreased by 4 times compared to the control group (OR – 0.24; 95% CI – 0.06-0.896). Peak oxygen consumption (p=0.03) and exercise tolerance (p=0.03) were significantly higher in the group of patients with the early rehabilitation according to CPET conducted three weeks after the surgery. At the present stage, it seems optimal to shift the start of physical rehabilitation in postoperative period to the earlier dates. Minimizing the patient’s immobilization period helps to optimize the course of the postoperative period. Conclusion. Early rehabilitation in the postoperative period of CABG in patients with frailty is associated with lower incidence of postoperative complications and improvements in physical capacity of patients by the end of the hospital stay