SUMMARIES FOR PATIENTS
A Preoperative Program for Patients Awaiting Coronary Artery Bypass Graft (CABG) Surgery
15 August 2000 | Volume 133 Issue 4 | Page 253
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The summary below is from the full report titled "Effect of a Preoperative Intervention on Preoperative and Postoperative Outcomes in Low-Risk Patients Awaiting Elective Coronary Artery Bypass Graft Surgery. A Randomized, Controlled Trial." It is in the 15 August 2000 issue of Annals of Internal Medicine (volume 133, pages 253-262). The authors are H.M. Arthur, C. Daniels, R. McKelvie, J. Hirsh, and B. Rush.
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What is the problem and what is known about it so far?
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In some countries, patients often have to wait for medical procedures such as coronary artery bypass graft (CABG) surgery. In CABG surgery, blocked blood vessels that deliver blood to the heart are replaced with artificial vessels or ones taken from elsewhere in the body. For many patients, CABG is elective, meaning that it is judged to be relatively safe for them to wait for surgery. However, patients' emotional state and ability to perform their usual activities can deteriorate while they wait. Since waits for CABG can't always be avoided, it makes sense to involve waiting patients in programs that can improve the outcomes of surgery.
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Why did the researchers do this particular study?
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To evaluate the effect of a special preoperative program on patients awaiting CABG surgery.
The study included 249 male and female patients in Ontario, Canada, who were scheduled to wait at least 10 weeks for elective CABG surgery.
The researchers assigned study patients at random to receive usual care or to enter a program that included exercise training twice per week, education, and monthly telephone calls from a nurse. The main end points were how long patients stayed in the hospital and in an intensive care unit at the time of their CABG surgery. The researchers measured patients' quality of life, social supports, anxiety levels, use of health services, and performance on an exercise test.
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What did the researchers find?
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Patients in the program spent about 1 less day in the hospital and 2 fewer hours in the intensive care unit than patients who got usual care. While they waited and up to 6 months after surgery, program patients reported better quality of life than those not in the program. Program patients did not show improvements in anxiety level, exercise ability, social support, or use of health services during the waiting period, however. Six months after surgery, program patients reported better levels of social support. Complications and deaths did not differ between the groups.
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What were the limitations of the study?
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These results might not apply to sicker patients or to patients whose waiting times for surgery were shorter than 10 weeks. In addition, this study does not tell us which part of the program was responsible for the benefits observed.
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What are the implications of the study?
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This study suggests that it is possible to develop programs for patients awaiting CABG surgery that result in improved outcomes after surgery. More generally, programs such as this may make productive use of the waiting periods that are inevitable in some health care systems.
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