Key result
Perioperative rehabilitation fails to reduce composite post-cardiac surgery outcomes, despite lowering pulmonary complications.
Why the study?
Does a perioperative rehabilitation bundle reduce a composite of postoperative pulmonary complications, prolonged hospitalization, and in-hospital mortality in patients undergoing elective cardiac valve surgery?
RCT (n=818)
randomized
No
Does a perioperative rehabilitation bundle reduce a composite of postoperative pulmonary complications, prolonged hospitalization, and in-hospital mortality in patients undergoing elective cardiac valve surgery?
Odds Ratio: 0.881 (95% CI 0.663–1.167)
Absolute Event Rate: 51.6% vs 53.5%
p-value: p=0.376
While a perioperative rehabilitation bundle did not reduce the primary composite outcome, it significantly reduced the incidence of postoperative pulmonary complications in patients undergoing cardiac valve surgery.
Background Patients with valvular heart disease are at high risk for postoperative pulmonary complications (PPCs), which contribute to morbidity and mortality after surgery. However, few studies have specifically focused on perioperative rehabilitation in this patient population. Methods This single-center, randomized controlled trial evaluated a perioperative rehabilitation (PORT) bundle comprising four components: education, inspiratory muscle training (IMT), active cycle of breathing techniques (ACBT), and early mobilization (EM). The primary outcome was a composite measure of the occurrence of PPCs within the first 7 days, postoperative hospitalization exceeding 7 days, and in-hospital all-cause mortality, with each component also considered individually. Secondary outcomes included the length of stay in the surgical intensive care unit, total postoperative hospitalization 3-month all-cause mortality, and non-surgical costs. Results Both groups were comparable at baseline. After surgery, the composite outcome was observed in 206 (51.6%) of 399 patients in the PORT group and 224 (53.5%) of 419 patients in the usual care group (odds ratio [OR], 0.881; 95% confidence interval [CI], 0.663 to 1.167, p = 0.376). PPCs were present in 161 (40.4%) patients in the PORT group and 197 (47.1%) patients in the usual care group (OR, 0.720; 95% CI, 0.541 to 0.956, p = 0.023). Postoperative hospital stay was prolonged to more than 7 days in 241 (29.5%) of 818 patients, with no significant difference between the two groups. Deaths occurred in 3 (0.8%) patients receiving perioperative rehabilitation and 4 (1%) patients receiving usual care (hazard ratio [HR] 0.648; 95% CI, 0.140 to 2.993, p = 0.578). No significant differences were found between groups for secondary outcomes. Conclusions The results of this study indicate that perioperative rehabilitation significantly reduces the incidence of PPCs in patients with valvular heart disease. Therefore, we recommend incorporating comprehensive perioperative rehabilitation into the clinical management of patients undergoing cardiac valve surgery.
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Ma et al. (2025) conducted an RCT in valvular heart disease (n=818). perioperative rehabilitation (PORT) bundle vs. usual care was evaluated on composite measure of the occurrence of PPCs within the first 7 days, postoperative hospitalization exceeding 7 days, and in-hospital all-cause mortality (OR 0.881, 95% CI 0.663 to 1.167, p=0.376). Perioperative rehabilitation did not reduce the primary composite outcome (OR 0.881; p=0.376) but significantly reduced postoperative pulmonary complications (40.4% vs 47.1%; OR 0.720; p=0.023).
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