Early, dedicated follow-up and treatment of pleural effusions enhance the recovery rate after open cardiac surgery: results from a randomized, clinical trial

OBJECTIVES: Recent studies conclude that cardiac surgery patients are prone to both mortality and morbidity in the weeks after discharge. Complications such as pleural and pericardial effusions may influence physical recovery due to symptoms such as dyspnoea, chest pain and fatigue. Dedicated follow-up and timely treatment of postoperative complications are suggested. METHODS: A randomized, controlled intervention trial including 76 patients, in the ratio of 1 : 1. Patients scheduled for elective on-pump coronary artery bypass grafting and/or aortic valve replacement were eligible for inclusion. Patients were randomized to either standard postoperative care or complementary follow-up visits with clinical examinations, focused chest sonography and protocol-driven thoracentesis if applicable. Primary outcomes were the mean change in walking distance, peak expiratory flow and EuroQOL from baseline to 30 days after surgery. RESULTS: The mean difference in walking distance after 30 days was 15% ( 65 +/- 22 m) between groups, P = 0.017. No differences were found in the peak expiratory flow or EuroQOL. In patients with pleural effusion, walking distance improved by 22% after thoracentesis ( 81 +/- 42 m), P < 0.0001, and peak expiratory flow improved by 26% ( 1.1 +/- 1.2 l/min), P < 0.001. CONCLUSIONS: Supplemental dedicated follow-up and treatment of postoperative effusions enhance recovery by 15% compared with standard care, measured by improvement in the walking distance 1 month after cardiac surgery.