Key result
Delayed postoperative ambulation after isolated coronary artery bypass grafting was associated with an increased risk of long-term adverse events, with the risk increasing by 4% for each day of delay (HR 1.04).
Why the study?
The effect of delayed ambulation on outcomes following coronary artery bypass grafting remained to be clarified.
Does early ambulation improve long-term and in-hospital outcomes in patients who underwent isolated CABG?
Cohort (n=887)
No
Does early ambulation improve long-term and in-hospital outcomes in patients who underwent isolated CABG?
Hazard Ratio: 1.04 (95% CI 1.02–1.06)
Absolute Event Rate: 26.2% vs 15.9%
p-value: p=<0.001
Early ambulation within 3 days after isolated CABG is associated with a significantly lower risk of postoperative complications and long-term adverse events.
May support early ambulation post-CABG; leaves open confirmation of benefit in randomized trials.
BACKGROUND: The effect of delayed ambulation on the outcome of coronary artery bypass grafting (CABG) remains to be clarified. METHODS AND RESULTS: The long-term and in-hospital outcomes of 887 patients who underwent isolated CABG (455 off-pump cases, 135 urgent cases) were evaluated, with a focus on the timing of first ambulation. In-hospital mortality cases were excluded. Early ambulation (first ambulation within 3 days after operation) was achieved in 339 (38%) patients. In the multivariable logistic regression analysis, longer operation time and urgent case, EuroSCORE II, re-thoracotomy, and respiratory time were associated with delayed (≥4 days) ambulation. Delayed ambulation was associated with a high incidence of postoperative complications, such as pneumonia, and stroke (P<0.01). Following discharge, 22.2% of patients experienced major cardiac events and 13.8% died during the follow-up period (median follow-up 60 months). Cox hazards analysis revealed that delayed ambulation was associated with long-term adverse events (hazard ratio 1.04 per day, P<0.001). With adjustment for preoperative factors, the estimated future risk of adverse events was found to be increased day-by-day during the delay until initial ambulation. CONCLUSIONS: In isolated CABG patients, delayed ambulation was associated with poor outcomes, even in the long-term period. The results support the current guideline recommending early ambulation protocol after cardiac surgery.
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Tsuchikawa et al. (2022) conducted a cohort in Coronary Artery Disease requiring CABG (n=887). Delayed ambulation (≥4 days post-operation) vs. Early ambulation (within 3 days post-operation) was evaluated on Long-term adverse events (all-cause death and cardiac events) (HR 1.04, 95% CI 1.02-1.06, p=<0.001). Delayed postoperative ambulation after isolated coronary artery bypass grafting was associated with an increased risk of long-term adverse events, with the risk increasing by 4% for each day of delay (HR 1.04).
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