초록접수 현황
| 15F-035 | 구연 발표 |
Routine Application of a Critical Pathway in Elective Isolated Off-Pump Coronary Artery Bypass Grafting
Kwang Ree Cho, Eun Ah Lee, Kyung Hee Shin, Jeong-Won Kim, Hyung Tae Sim,
Hyoung Woo Chang, Jae Suk Yoo, Dong Jin Kim.
Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital, Gyeonggi-do, Republic of Korea
Background : To standardize the quality of postoperative care in patients undergoing elective isolated off-pump coronary artery bypass grafting (OPCAB), we routinely applied our institutional critical pathway (CP) protocol. Our institutional CP was constructed with a total of 8-day protocol to accomplish the hospital discharge on postoperative 7th day.
Methods : Between June 2014 and August 2015, 103 cases of elective isolated OPCAB were intended to go on our institutional CP protocol. Mean age was 63 ± 10 (39-91) years. Mean left ventricular ejection fraction (LVEF) was 52 ± 13 (15-74) %. Severe LV dysfunction (LVEF≦35%) was present in 16 (15%) patients. Eleven patients (11%) had history of stroke and 9 (9%) carried chronic kidney disease. Left main coronary artery disease was present in 30 (29%) patients. Thirty seven (36%) patients were presented with acute coronary syndrome.
Results : Internal thoracic arteries (ITAs) were used in all patients (bilateral ITAs use in 97%). Mean number of distal anastomosis was 3.7 ± 1.0. There was no in-hospital mortality. Postoperative complications were 8 (8%) temporary atrial fibrillation, 3 (3%) wound dehiscence, 2 (2%) transient ischemic attack, and 1 (1%) mediastinitis. Success rate of CP was 72% (74/103). Causes of drop-out were 8 blood sugar control, 6 rejections to discharge, 4 wound problems, 2 liver enzyme elevation, and other minor problems. Readmissions were needed in 11 (11%) patients, of whom 8 (%) were related to the OPCAB. Reasons for re-admission were 3 wound problems, 2 melenas, 1 hybrid PCI, hyponatremia, and headache.
Conclusion : Routine application of CP in elective isolated OPCAB was feasible in most of the cases. Application of CP might shorten the hospital stay from standardized postoperative cares.
Methods : Between June 2014 and August 2015, 103 cases of elective isolated OPCAB were intended to go on our institutional CP protocol. Mean age was 63 ± 10 (39-91) years. Mean left ventricular ejection fraction (LVEF) was 52 ± 13 (15-74) %. Severe LV dysfunction (LVEF≦35%) was present in 16 (15%) patients. Eleven patients (11%) had history of stroke and 9 (9%) carried chronic kidney disease. Left main coronary artery disease was present in 30 (29%) patients. Thirty seven (36%) patients were presented with acute coronary syndrome.
Results : Internal thoracic arteries (ITAs) were used in all patients (bilateral ITAs use in 97%). Mean number of distal anastomosis was 3.7 ± 1.0. There was no in-hospital mortality. Postoperative complications were 8 (8%) temporary atrial fibrillation, 3 (3%) wound dehiscence, 2 (2%) transient ischemic attack, and 1 (1%) mediastinitis. Success rate of CP was 72% (74/103). Causes of drop-out were 8 blood sugar control, 6 rejections to discharge, 4 wound problems, 2 liver enzyme elevation, and other minor problems. Readmissions were needed in 11 (11%) patients, of whom 8 (%) were related to the OPCAB. Reasons for re-admission were 3 wound problems, 2 melenas, 1 hybrid PCI, hyponatremia, and headache.
Conclusion : Routine application of CP in elective isolated OPCAB was feasible in most of the cases. Application of CP might shorten the hospital stay from standardized postoperative cares.
책임저자: Kwang Ree Cho
Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital, Gyeonggi-do, Republic of Korea
연락처 : Hyung Tae Sim, Tel: 032-340-1440 , E-mail : artistsim@naver.com
