Abstract
It is unclear when to begin rehabilitation after coronary artery bypass grafting (CABG) in the intensive care unit (ICU). Using the Japanese Diagnosis Procedure Combination inpatient database from 2010 to 2018, we identified adult patients who underwent a CABG and who were admitted to the ICU for ≥3 consecutive days from the date of their CABG. Patients who started any rehabilitation program prescribed by physicians or therapists within 3 days of CABG were defined as the early rehabilitation group, and the remaining patients were defined as the usual care group. We identified 30,568 eligible patients, with 13,150 (43%) patients in the early rehabilitation group. An inverse probability of treatment weighting analyses showed that the Barthel Index score at discharge in the early rehabilitation group was significantly higher than that in the usual care group (difference: 3.2; 95% confidence interval: 1.5–4.8). The early rehabilitation group had significantly lower in-hospital mortality, total hospitalization costs, length of ICU stay, and hospital stay vs. the usual care group. Our results suggested that early rehabilitation by physicians or therapists beginning within 3 days of CABG was safe, as suggested by the low mortality and improved physical function in patients who underwent CABG.
Highlights
Patients admitted to intensive care units (ICUs) can experience physical disabilities, cognitive impairments, or psychological difficulties, which are related to post-intensive care syndrome (PICS)
2010 to 31 March 2018, we identified patients who underwent coronary artery bypass grafting (CABG) and who were admitted to the ICU for more than 3 consecutive days from the date of CABG
The present study using nationwide real-world data showed that early rehabilitation beginning within 3 days of CABG prescribed by physicians or therapists was significantly associated with improved ADLs at discharge after the CABG
Summary
Patients admitted to intensive care units (ICUs) can experience physical disabilities, cognitive impairments, or psychological difficulties, which are related to post-intensive care syndrome (PICS). Patients with PICS have a very poor long-term health-related quality of life; maintaining activities of daily living (ADLs) during hospitalization is important [5]. Mobilization, or active exercise programs are increasingly being provided to maintain ADLs and independence for critically ill patients in ICUs [6]. Following CABG, patients are more likely to have physical impairments and PICS because of their low cardiac function, the risk of ischemia, and the surgical invasiveness [7]. Cardiac rehabilitation has been widely performed with patients after a CABG. The timing of cardiac rehabilitation is divided into phase 1 (acute stage: within 7 days of onset), phase 2 (healing stage: from 1 week to 6 months after onset), and phase 3
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