Abstract 10000: Improving a Patient's Readiness for Coronary Artery Bypass Graft Surgery
BACKGROUND: Many evidence-based, pre-operative strategies have been identified that can improve outcomes for patients following coronary artery bypass surgery (CABG). We hypothesized that implementing a series of strategies - "a bundle" - to optimize a patient's readiness for surgery would be associated with improved outcomes.
METHODS: Eight centers in northern New England undertook a nurse-driven initiative to improve readiness for CABG either by using a checklist or by updating their standard orders. The bundled pre-operative strategies included: use of aspirin, beta-blocker, and lipid-lowering agent, hematocrit >30 mg/dL, 6 AM glucose <150 mg/dL, operating ≥3 days after an MI, and induction heart rate<80 bpm. Data were collected on the last 150 isolated CABG operations at each institution (n=1200) from 7/08 through 6/10. 84 emergency cases were excluded. A bundle score of 0-100 was calculated for each patient to represent the percentage of applicable strategies applied. Missing data, medication contraindications and selective strategies (eg. for MI patient only) were accounted for. The association between bundle scores (<80; 80-99; 100) and time to extubation and post-operative length of stay (LOS) was assessed using Kaplan-Meier methods and log rank tests.
RESULTS: Scores ranged from 33 to 100. 57% of patients had a perfect score, 28% a score of 80-99 and 15% a score <80. Higher bundle scores were associated with shorter times to extubation (Figure). Median LOS was shorter for patients with higher scores: 5 days for score 100; 6 days for scores 80-99 and for scores <80 (log rank p-value<0.001). When adjusted for patient and disease characteristics results were similar.
CONCLUSION: Successful implementation of evidence-based strategies to optimize a patient's “readiness for surgery” is associated with shorter extubation time and length of stay after CABG surgery.
- © 2011 by American Heart Association, Inc.