Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial

Artur H Herdy, Patrícia L B Marcchi, Adriano Vila, Claudia Tavares, Jauro Collaço, Josef Niebauer, Jorge P Ribeiro
American Journal of Physical Medicine & Rehabilitation 2008, 87 (9): 714-9

OBJECTIVE: Patients who have to wait in the hospital for coronary artery bypass surgery (CABG) are exposed to the potential risks of immobilization. This clinical trial was conducted to evaluate the effects of an in-hospital cardiopulmonary rehabilitation program performed before and after CABG on postoperative outcomes.

DESIGN: Fifty-six patients who had to wait for CABG in-hospital were randomly assigned to a cardiopulmonary rehabilitation (Rehab; n = 29) or to usual care (Control; n = 27). In the Rehab group, intervention lasted for at least 5 days preoperatively until discharge. The program consisted of phase I cardiac rehabilitation associated with respiratory physical therapy. Outcomes were blindly evaluated.

RESULTS: By hospital discharge, Rehab patients presented a shorter time to endotracheal extubation (1054 +/- 376 vs. 1340 +/- 666 min, P = 0.05), a reduction in the incidence of pleural effusion (relative risk [RR] = 0.2; 95% confidence interval [CI]: 0.5-0.8), atelectasis (RR = 0.15; 95% CI: 0.03-0.8), pneumonia (0 vs. 7 cases, [P = 0.004]), and atrial fibrillation or flutter (RR = 0.2; 95% CI: 0.05-0.8). Length of in-hospital stay after surgery was also reduced in the Rehab group (5.9 +/- 1.1 vs. 10.3 +/- 4.6 days [P < 0.001]).

CONCLUSION: Pre- and postoperative cardiopulmonary rehabilitation in patients who await CABG in the hospital is superior to standard care and leads to a reduced rate of postoperative complications and shorter hospital stay.

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