Physical function examination at intensive care unit as predictive indicators for hospitalization-associated disability in patients after cardiovascular surgery.

Go Haraguchi,Mitsuaki Isobe,Tomoki Shimokawa,Atsuko Nakayama,Keigo Iwai,Masakazu Saitoh,Kentaro Hori,Shuichiro Takanashi,Kotaro Hirakawa,Takeshi Arimitsu

doi:10.31083/j.rcm2302077

Abstract

Following cardiovascular surgery, patients are at high risk of requiring systemic management in the intensive care unit (ICU), resulting in hospitalization-associated disability (HAD). Predicting the risk of HAD during the postoperative course is important to prevent susceptibility to cardiovascular events. Assessment of physical function during the ICU stay may be useful as a prediction index but has not been established. This prospective observational study conducted at a high-volume cardiovascular center included 236 patients (34% female; median age, 73 years) who required an ICU stay of at least 72 hours after surgery and underwent postoperative rehabilitation. HAD was defined as a decrease in the discharge Barthel index (BI) score of at least 5 points relative to the preadmission BI score. Physical Function ICU Test-scored (PFIT-s), Functional Status Score for the ICU (FSS-ICU), and Medical Research Council (MRC)-sumscore were used to assess physical function at ICU discharge. HAD occurred in 58 (24.6%) of the 236 patients following cardiovascular surgery. The cut-off points for HAD were 7.5 points for the PFIT-s (sensitivity 0.80, specificity 0.59), 24.5 points for the FSS-ICU (sensitivity 0.57, specificity 0.66), and 59.5 points for the MRC-sumscore (sensitivity 0.93, specificity 0.66). Multivariate logistic regression analysis revealed a PFIT-s of >7.5 points (odds ratio [OR], 4.84; 95% CI, 2.39-9.80; p < 0.001) and an MRC-sumscore of >59.5 points (OR, 2.43; 95% CI, 1.22-4.87; p = 0.012) as independent associated factors. We demonstrate that the PFIT-s and MRC-sumscore at ICU discharge may be helpful as a predictive indicator for HAD in patients having undergone major cardiovascular surgery.

Highlights

The development of surgical techniques and advancements in perioperative management for cardiovascular surgery have enabled an improvement in life saving, a shortening of the postoperative hospital stay, and the start of early rehabilitation
The cut-off point for hospitalization-associated disability (HAD) was 7.5 points for the Physical Function ICU Test-scored (PFIT-s), 24.5 points for the FSS-intensive care unit (ICU), and 59.5 points for the Medical Research Council (MRC)-sumscore (Fig. 2)
Multivariate logistic regression analysis revealed age, body mass index (BMI), Acute Physiology and Chronic Health Evaluation (APACHE) II score, postoperative delirium, the starting date of standing, PFIT-s, FSS-ICU, and MRC-sumscore at ICU discharge as independent variables

Summary

Introduction

The development of surgical techniques and advancements in perioperative management for cardiovascular surgery have enabled an improvement in life saving, a shortening of the postoperative hospital stay, and the start of early rehabilitation. Patients are at high risk of requiring systemic management in the intensive care unit (ICU), resulting in hospitalization-associated disability (HAD). Methods: This prospective observational study conducted at a high-volume cardiovascular center included 236 patients (34% female; median age, 73 years) who required an ICU stay of at least 72 hours after surgery and underwent postoperative rehabilitation. Physical Function ICU Test-scored (PFIT-s), Functional Status Score for the ICU (FSS-ICU), and Medical Research Council (MRC)-sumscore were used to assess physical function at ICU discharge. Conclusions: We demonstrate that the PFIT-s and MRC-sumscore at ICU discharge may be helpful as a predictive indicator for HAD in patients having undergone major cardiovascular surgery

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Discussion

Conclusion