TY - JOUR
T1 - Early, dedicated follow-up and treatment of pleural effusions enhance the recovery rate after open cardiac surgery
T2 - results from a randomized, clinical trial
AU - Hansen, Laura Sommer
AU - Hjortdal, Vibeke Elisabeth
AU - Jakobsen, Carl-Johan
AU - Heiberg, Johan
AU - Maagaard, Marie
AU - Sloth, Erik
N1 - © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2017
Y1 - 2017
N2 - 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.CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02045641.UNIQUE IDENTIFIER: NCT02045641.
AB - 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.CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02045641.UNIQUE IDENTIFIER: NCT02045641.
U2 - 10.1093/ejcts/ezw233
DO - 10.1093/ejcts/ezw233
M3 - Journal article
C2 - 27401709
VL - 51
SP - 58
EP - 66
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 1
ER -