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Cardiac Surgery? Up and Out!
My father-in-law has isolated coronary artery bypass grafting surgery tomorrow. Based on the study below, I will encourage him to have cardiac surgery and leave the hospital as soon as he is able.
I say this because the study below seems to encourage early release after cardiac surgery. I am a long-term cancer survivor.
I have a love/hate relationship with medicine. I research and write about medical issues. I have this idea that many bad things happen while the patient is IN the hospital. Just walking is healthy. And returning home should improve my FIL’s diet compared to the food he is eating at the hospital.
The fact that doctors can take a vein from my FIL’s leg and bypass an occlusion in his heart is a spectacular. At the same time, there are too many things that can go wrong when staying in a hospital.
What are the pros and cons of cardiac surgery?
Pros
- Life-Saving Potential:
- Treatment of Life-Threatening Conditions: Cardiac surgery can treat serious heart conditions such as coronary artery disease, heart valve disease, and congenital heart defects, potentially saving the patient’s life.
- Prevention of Heart Attacks: Procedures like coronary artery bypass grafting (CABG) can prevent future heart attacks by improving blood flow to the heart.
- Improved Quality of Life:
- Symptom Relief: Surgery can alleviate symptoms such as chest pain (angina), shortness of breath, and fatigue, improving overall quality of life.
- Increased Activity Levels: Many patients experience improved physical capability and can engage in activities that were previously limited.
- Long-Term Benefits:
- Prolonged Lifespan: Successful cardiac surgery can significantly extend a patient’s lifespan by addressing the underlying issues that could lead to fatal complications.
- Enhanced Heart Function: Procedures that repair or replace heart valves, repair heart defects, or bypass blocked arteries can result in better heart function and efficiency.
- Technological Advancements:
- Minimally Invasive Options: Advances in medical technology have led to the development of minimally invasive surgical techniques, which can reduce recovery time, minimize scarring, and lower the risk of complications.
Cons
- Risks and Complications:
- Surgical Risks: All surgeries carry inherent risks such as infection, bleeding, and adverse reactions to anesthesia.
- Post-Surgical Complications: Specific to cardiac surgery, there can be risks of heart attack, stroke, blood clots, arrhythmias, and other complications.
- Recovery Period:
- Lengthy Recovery: The recovery period after cardiac surgery can be long and challenging, often requiring weeks or months for full recovery.
- Physical Limitations: During recovery, patients may experience physical limitations and require assistance with daily activities.
- Emotional and Psychological Impact:
- Stress and Anxiety: Undergoing heart surgery can be emotionally taxing, causing stress and anxiety for both the patient and their family.
- Depression: Some patients may experience depression or mood changes following surgery.
- Financial Costs:
- High Medical Costs: Cardiac surgery can be expensive, and even with insurance, the out-of-pocket costs for the surgery and postoperative care can be significant.
- Long-Term Medication and Follow-Up: Patients may need ongoing medication and regular follow-up appointments, adding to the overall cost.
- Lifestyle Changes:
- Lifestyle Modifications: Patients often need to make significant lifestyle changes post-surgery, such as diet modifications, quitting smoking, and adhering to an exercise regimen.
- Variable Outcomes:
- Uncertain Results: The success of cardiac surgery can vary based on the individual’s condition, age, and overall health. Some patients may not experience the desired improvement in symptoms or quality of life.
All in all, my FIL’s cardiac surgery is a wonder of medical science in my opinion. I am simply adding a little complementary thinking.
Good luck,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Study: Short Hospital Stays OK After Cardiac Surgery
“Accelerated discharge from the hospital after elective cardiac surgery may not result in the most feared unintended consequences, according to one center’s experience.
A review of patients who had cardiac surgery in 2004-2017 (excluding urgent and emergent cases) showed that early discharge, where the patient left the hospital within three days, was associated with:
- 0% 30-day mortality (same as with a longer hospital stay)
- 0% in-hospital major morbidity (vs 7%, P=0.001)
- 8% readmission within 30 days (vs 6%)
- 2% postoperative atrial fibrillation (Afib; vs 19%, P<0.001)
- 0% permanent pacemaker implants (vs 1%)
Short lengths of stay are therefore “very safe,” and the present data can be used to reassure patients that it’s okay to go home early, said S. Chris Malaisrie, MD, of Northwestern Medicine in Chicago, during a press conference here at the Society of Thoracic Surgeons (STS) meeting.
Reducing the time a patient spends in the hospital is part of an Enhanced Recovery After Surgery (ERAS) protocol, a large, multidisciplinary care initiative with the goal of improving overall patient outcomes.
ERAS is a bundle of protocols spanning the various phases of the patient’s care, from the preoperative (education for the patient, diet, and exercise) to the postoperative (reduced opioids, transition to home), explained Daniel Engelman, MD, of Baystate Medical Center in Springfield, Massachusetts, and president of the ERAS Cardiac Society, which is working with STS to support the rollout of the program.
Worries about the ERAS program are about whether it’s just about getting the patient out of the hospital sooner, Engelman said at the press conference: “It’s not. It’s an evidence-based program that gets them out at the right time. If it’s done the way it was done at Northwestern, it can be done without increasing complications,” he emphasized.
“Despite how much [time we] spend discussing how we operate on patients, 80% of morbidity and mortality after cardiac surgery actually occurs outside of the operating room. That includes patients who are inadequately prepared for surgery: they aren’t given proper nutrition, they haven’t quit smoking … [or gotten] alcohol under control,” he said.
Study Details
For the study, Malaisrie and colleagues found that patients stayed a median of six days in the hospital after cardiac surgery at Northwestern. Out of nearly 6,000 people, just 2.2% had a 3-day length of stay or less. After 1:3 propensity score matching, the investigators compared the outcomes of 121 short-stay patients and 357 longer-stay peers.
The two groups shared similar baseline characteristics: younger age (average 51 years), predominantly men, and very low surgical risk (STS score 0.4%). The most common surgeries undertaken were mitral valve repairs, isolated coronary artery bypass grafting, and isolated aortic valve replacements.
These data cannot determine causality between early discharge and postoperative Afib, Malaisrie cautioned.
The study also limited the conclusions that could be drawn about patients who need to go under the knife urgently or in an emergent fashion — dissections or acute heart attacks, for example — Malaisrie said. “We’re going to exclude these urgent patients from our ERAS program.”
Engelman had a different perspective: For those patients, there wouldn’t be the preoperative component, but the perioperative and postoperative initiatives may still be valid. “I believe every patient is a candidate for postop ERAS,” he said, adding that reducing opioids and using multimodal anesthesia are “low-hanging fruit.”
ERAS protocols are ubiquitous in Europe, and most major programs in North America are in some stage of adopting them, Engelman noted.