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Allahbakhshian A, Khalili AF, Gholizadeh L, Esmealy L. Comparison of early mobilization protocols on postoperative cognitive dysfunction, pain, and length of hospital stay in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial. Appl Nurs Res 2023; 73:151731. [PMID: 37722799 DOI: 10.1016/j.apnr.2023.151731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023]
Abstract
Although coronary artery bypass graft (CABG) surgery improves the life expectancy of patients with coronary artery disease, it is associated with various short and long-term complications. Early mobilization has been shown to reduce the risk of these complications. This study aimed to compare the effectiveness of different early mobilization protocols on postoperative cognitive dysfunction (POCD), pain intensity, and length of hospital stay (LOS) in patients undergoing CABG. This three-arm parallel randomized controlled trial included 120 patients undergoing CABG surgery who were randomly assigned to Intervention A, which received a four-phase early mobilization protocol; Intervention B, which received a three-phase early mobilization protocol; and the Control group, which received routine care. Postoperative cognitive dysfunction and pain were assessed using Mini Mental State Examination (MMSE) and visual analog scale (VAS), respectively. Groups were comparable in demographic and clinical characteristics and postoperative cognitive dysfunction at baseline. After the intervention, Group B had statistically significantly (p < 0.001) less cognitive dysfunction (25.8 ± 1.7) compared to Group A (24.1 ± 2.2) and the Control Group (23.4 ± 2.7). Likewise, hospital stay was statistically (p < 0.01) shorter for Group B (7.7 ± 1.5) than the Control group (8.9 ± 1.9). However, the experience of pain was statistically significantly lower over time in Group A than in the other groups (p < 0.001). This study concludes that an early mobilization protocol based on deep breathing exercises and chest physiotherapy may better improve postoperative cognitive dysfunction and length of hospital stay than an early mobilization protocol based on passive and active range of motion activities or routine care.
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Affiliation(s)
- Atefeh Allahbakhshian
- Department of Medical-Surgical, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azizeh Farshbaf Khalili
- Department of Physical Medicine Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Leyla Esmealy
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Leonardi B, Sagnelli C, Fiorelli A, Leone F, Mirra R, Pica DG, Di Filippo V, Capasso F, Messina G, Vicidomini G, Sica A, Santini M. Application of ERAS Protocol after VATS Surgery for Chronic Empyema in Immunocompromised Patients. Healthcare (Basel) 2022; 10:healthcare10040635. [PMID: 35455813 PMCID: PMC9029650 DOI: 10.3390/healthcare10040635] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/13/2022] [Accepted: 03/24/2022] [Indexed: 02/05/2023] Open
Abstract
Enhanced recovery after surgery protocols have shown improved clinical outcomes after lung resection surgery, but their application after empyema surgery is still limited. We retrospectively evaluated the outcomes of an adapted enhanced recovery after surgery (ERAS) protocol for immunocompromised patients who underwent video-assisted thoracoscopic surgery (VATS) surgery for chronic empyema between December 2013 and December 2021. The patients were divided into an ERAS group and a conventional treatment group. Peri-operative data were collected and compared between the two groups. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative pain and post-operative complications (air leaks, atelectasis). A total of 86 patients, 45 in the ERAS group and 41 in the non-ERAS group, were considered. Chest tube duration (6.4 ± 2.3 vs. 13.6 ± 6.8 days) and post-operative length of stay (7.6 ± 1.6 vs. 16.9 ± 6.9 days) were significantly shorter in the ERAS group. The volume of chest drainage (103 ± 78 vs. 157 ± 89 mL/day) was significantly smaller in the ERAS group. There were no significant differences in operative time, blood loss, need for transfusion, tube reinsertion and median VAS score. The incidence of air leaks and atelectasis was significantly reduced in the ERAS group, as was the need for bronchoscopic aspiration. The application of an ERAS protocol after empyema VATS surgery for immunocompromised patients improved the surgical outcome, reducing the post-operative length of stay and rate of complications.
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Affiliation(s)
- Beatrice Leonardi
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Alfonso Fiorelli
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
- Correspondence: ; Tel.: +39-33-8103-0061
| | - Francesco Leone
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Rosa Mirra
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Davide Gerardo Pica
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Vincenzo Di Filippo
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Francesca Capasso
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Gaetana Messina
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Giovanni Vicidomini
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Mario Santini
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (B.L.); (F.L.); (R.M.); (D.G.P.); (V.D.F.); (F.C.); (G.M.); (G.V.); (M.S.)
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