What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery bypass grafting (n=30568). Intervention: Early rehabilitation within 3 days of CABG vs. Usual care. Primary outcome: Barthel Index score at discharge (Difference 3.2, 95% CI 1.5-4.8).

February 6, 2021Open Access

Effect of Early Rehabilitation on Physical Function in Patients Undergoing Coronary Artery Bypass Grafting: A Nationwide Inpatient Database Study

HOHiroyuki OhbeBunkyo University KNKensuke NakamuraJikei University School of Medicine KUKazuaki UdaNational Center for Geriatrics and Gerontology

Key Result

Early rehabilitation within 3 days of CABG significantly improved the Barthel Index score at discharge compared to usual care (difference: 3.2; 95% CI: 1.5-4.8).

Study Design

Type

Cohort (n=30,568)

Multicenter

Yes

Structured PICO

Does early rehabilitation within 3 days of CABG improve physical function at discharge in adult patients admitted to the ICU for ≥3 days?

Population

30,568 adult patients who underwent coronary artery bypass grafting (CABG) and were admitted to the ICU for ≥3 consecutive days from the date of their CABG, identified from the Japanese Diagnosis Procedure Combination inpatient database (2010-2018).

Intervention

Early rehabilitation (any rehabilitation program prescribed by physicians or therapists started within 3 days of CABG)

Comparator

Usual care (rehabilitation started after 3 days of CABG or not at all)

Outcome

Barthel Index score at dischargepatient reported

Early rehabilitation initiated within 3 days of CABG in ICU patients is associated with improved physical function at discharge, lower in-hospital mortality, and reduced hospital length of stay and costs.

Main Result

Effect estimate: Difference 3.2 (95% CI 1.5-4.8)

Abstract

It is unclear when to begin rehabilitation after coronary artery bypass grafting (CABG) in the intensive care unit (ICU). Using the Japanese Diagnosis Procedure Combination inpatient database from 2010 to 2018, we identified adult patients who underwent a CABG and who were admitted to the ICU for ≥3 consecutive days from the date of their CABG. Patients who started any rehabilitation program prescribed by physicians or therapists within 3 days of CABG were defined as the early rehabilitation group, and the remaining patients were defined as the usual care group. We identified 30,568 eligible patients, with 13,150 (43%) patients in the early rehabilitation group. An inverse probability of treatment weighting analyses showed that the Barthel Index score at discharge in the early rehabilitation group was significantly higher than that in the usual care group (difference: 3.2; 95% confidence interval: 1.5-4.8). The early rehabilitation group had significantly lower in-hospital mortality, total hospitalization costs, length of ICU stay, and hospital stay vs. the usual care group. Our results suggested that early rehabilitation by physicians or therapists beginning within 3 days of CABG was safe, as suggested by the low mortality and improved physical function in patients who underwent CABG.

Ask AI

Helpful

Bookmark

View Full Paper