Improving patients' readiness for coronary artery bypass graft surgery.
Critical care nurse
Aged, Aged, 80 and over, Coronary Artery Bypass, Female, Humans, Length of Stay, Male, Middle Aged, Myocardial Infarction, Organizational Case Studies, Perioperative Period, Postoperative Complications, Risk Factors, Treatment Outcome
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
CONCLUSION: Implementation of interventions to optimize patients' "readiness for surgery" is associated with shorter intubation times and shorter hospital stays after CABG.
Chaisson, Kristine; Sanford, Mary; Boss, Richard A; Leavitt, Bruce J; Hearne, Michael J; Ross, Cathy S; Olmstead, Elaine M; Kramer, Robert S; Hofmaster, Patricia; Mingo, Cathy; Duquette, Dennis; Maislen, Elizabeth; Clark, Jean A; Likosky, Donald S; Horton, Susan R; O'Connor, Gerald T; and Malenka, David J, "Improving patients' readiness for coronary artery bypass graft surgery." (2014). Maine Medical Center. 76.