Study: Preoperative interventions improve outcomes of patients undergoing CABG surgery

A quality improvement initiative improved the outcomes of patients undergoing cardiac surgery at select medical centers in northern New England, according to a study in the December issue of Critical Care Nurse (CCN).

The study, "Improving Patients' Readiness for Coronary Artery Bypass Graft (CABG) Surgery," found that implementing interventions to optimize patients' readiness for surgery was associated with reduced risk of mortality and morbidity, shorter intubation times and shorter hospital stays for urgent patients after CABG surgery.

As part of the study, members of the Northern New England Cardiovascular Disease Study Group (NNECDSG) implemented a readiness bundle of preoperative interventions for urgent patients undergoing CABG surgery at eight medical centers in Maine, New Hampshire and Vermont.

The readiness bundle included seven evidence-based interventions:
•Preoperative use of aspirin (within seven days)
•Preoperative use of a beta-blocker (within 24 hours)
•Preoperative use of a statin-type lipid-lowering agent (within 24 hours)
•Preoperative hematocrit above 30 percent
•Glucose level less than 150 mg/dL at 6 a.m. on the day of surgery
•Delaying surgery a minimum of three days after an acute myocardial infarction
•Induction heart rate of less than 80 beats per minute

Lead author Kristine Chaisson, RN, BSN, CCRN, MS, executive director of the Heart and Vascular Center at Holy Cross Hospital in Fort Lauderdale, Florida, said, "It is both challenging and rewarding to implement evidence-based strategies into clinical practice with a team-based approach."

NNECDSG representatives examined data from the 150 most recent, urgent, isolated patients with CABG at each of the eight medical centers, for a total of 1,200 patients.

A scaled bundle score of 0 to 100 was calculated for each patient to represent the percentage of interventions applied.

In the bundle score analysis, all but two of the 1,200 patients had data for at least five of the seven interventions, which was a requirement to calculate a bundle score. More than half of the patients had a perfect readiness bundle score of 100.

Among the findings, patients with the highest scores had significantly shorter intubations and hospital stays. They were also at lower risk for morbidity and mortality.