Improving Patients' Readiness for Coronary Artery Bypass Graft Surgery

被引:4
作者
Chaisson, Kristine [1 ]
Sanford, Mary [2 ]
Boss, Richard A., Jr. [3 ]
Leavitt, Bruce J. [4 ]
Hearne, Michael J.
Ross, Cathy S. [5 ]
Olmstead, Elaine M. [5 ]
Kramer, Robert S. [6 ]
Hofmaster, Patricia [7 ]
Mingo, Cathy [7 ]
Duquette, Dennis [8 ]
Maislen, Elizabeth [9 ,10 ]
Clark, Jean A. [10 ]
Likosky, Donald S. [11 ,12 ]
Horton, Susan R. [13 ]
O'Connor, Gerald T. [14 ]
Malenka, David J. [10 ,11 ]
机构
[1] Concord Hosp, CV Serv, Concord, NH 03301 USA
[2] Catholic Med Ctr, Manchester, NH USA
[3] Concord Hosp, Concord, NH 03301 USA
[4] Fletcher Allen Hlth Care, Cardiothorac Surg, Burlington, VT USA
[5] Dartmouth Coll, Geisel Sch Med, Northern New England Cardiovasc Dis Study Grp, Hanover, NH 03755 USA
[6] Maine Med Ctr, Div Cardiothorac Surg, Portland, ME USA
[7] Eastern Maine Med Ctr, Bangor, ME USA
[8] Portsmouth Reg Hosp, Portsmouth, NH USA
[9] Dartmouth Coll, Geisel Sch Med, Lebanon, NH 03756 USA
[10] Dartmouth Hitchcock Med Ctr, Lebanon, NH 03766 USA
[11] Northern New England Cardiovasc Dis Study Grp, Ann Arbor, MI USA
[12] Univ Michigan, Sch Med, Ann Arbor, MI USA
[13] Cent Maine Med Ctr, Cent Maine Heart & Vasc Inst, Lewiston, ME USA
[14] Geisel Sch Med Dartmouth, Northern New England Cardiovasc Dis Study Grp, Dartmouth, NS, Canada
关键词
HOSPITAL MORTALITY; INTERVENTION; MORBIDITY;
D O I
10.4037/ccn2014951
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND Preoperative interventions improve outcomes for patients after coronary artery bypass surgery (CABG). OBJECTIVE To reduce mortality for patients undergoing urgent CABG. METHODS Eight centers implemented preoperative aspirin and statin, preinduction heart rate less than 80/min, hematocrit greater than 30%, blood sugar less than 150 mg/dL (8.3 mmol/L), and delayed surgery at least 3 days after a myocardial infarction. Data were collected on the last 150 isolated, urgent CABGs at each center (n=1200). A "bundle" score of 0 to 100 was calculated for each patient to represent the percentage of interventions used. RESULTS Scores ranged from 33 to 100. About 56% of patients had a perfect score. Crude mortality and composite rates were lower in patients with higher scores, but once adjusted for patient and disease characteristics, the difference in scores was not significant. Higher scores were associated with shorter intubation: 6.0 hours (score 100), 8.0 hours (score 80-99), 8.4 hours (score<80) (log-rank P<.001). Median length of stay was shorter for patients with higher scores: 5 days (score 100), 6 days (scores 80-99), and 6 days (scores <80) (log-rank P<.001). CONCLUSION Implementation of interventions to optimize patients' "readiness for surgery" is associated with shorter intubation times and shorter hospital stays after CABG.
引用
收藏
页码:29 / 36
页数:8
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