CABG
Conditions
Keywords
CABG, preoperative rehabilitation, postoperative rehabilitation
Brief summary
Coronary artery bypass grafting (CABG) may be associated with prolonged recovery, particularly in high-risk patients. Although preoperative rehabilitation has shown promising results, evidence remains limited because of heterogeneous intervention protocols and variations in postoperative care. This study aims to investigate the effects of a structured inpatient physiotherapy program initiated at least two days before surgery and continued postoperatively, compared with the same structured physiotherapy program provided only during the postoperative period, in high-risk CABG patients. The primary outcome is hospital length of stay. Secondary outcomes include intensive care unit length of stay, C-reactive protein, neutrophil-to-lymphocyte ratio, hemoglobin, dyspnea, and fatigue.
Detailed description
Coronary artery bypass grafting (CABG) is commonly performed for the treatment of coronary artery disease. Postoperative recovery may be prolonged in patients with advanced age, reduced left ventricular ejection fraction, multivessel coronary artery disease, smoking history, and multiple comorbidities. Preoperative rehabilitation has been proposed as a strategy to support postoperative recovery. However, previous studies have used heterogeneous intervention protocols and different postoperative care approaches. This study will compare two physiotherapy strategies in high-risk CABG patients. Participants in the intervention group will receive a structured inpatient physiotherapy program initiated at least two days before surgery and continued postoperatively. The program includes breathing exercises, incentive spirometry, bronchial hygiene techniques, progressive early mobilization, and postural exercises. Before surgery, one supervised session will be provided daily, and participants will be instructed to repeat the program independently twice daily. Participants in the control group will receive the same structured physiotherapy program only during the postoperative period. The primary outcome is hospital length of stay. Secondary outcomes include intensive care unit length of stay, hemoglobin, C-reactive protein, neutrophil-to-lymphocyte ratio, dyspnea, and fatigue.
Interventions
OTHERPreoperative and Postoperative Structured Inpatient Physiotherapy
Participants will receive a structured inpatient physiotherapy program initiated at least two days before CABG surgery and continued throughout postoperative hospitalization. The program includes breathing exercises, incentive spirometry, bronchial hygiene techniques, progressive early mobilization, and postural exercises. Before surgery, one supervised session will be provided daily, and participants will be instructed to repeat the program independently twice daily.
OTHERPostoperative Structured Inpatient Physiotherapy
Participants will receive the same structured inpatient physiotherapy program only during the postoperative hospitalization. The program includes breathing exercises, incentive spirometry, bronchial hygiene techniques, progressive early mobilization, and postural exercises.
Sponsors
Bezmialem Vakif University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants will be randomly assigned to one of two parallel groups. The intervention group will receive a structured inpatient physiotherapy program initiated at least two days before coronary artery bypass grafting (CABG) and continued postoperatively. The control group will receive the same structured physiotherapy program only during the postoperative period.
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older. * Scheduled to undergo elective coronary artery bypass grafting (CABG). * High-risk patients meeting at least three of the following criteria: Left ventricular ejection fraction (LVEF) \<40%. Three-vessel coronary artery disease. More than two comorbidities. History of smoking. Age \>65 years. \- Able and willing to provide written informed consent.
Exclusion criteria
* Planned redo CABG surgery. * Severe neurological or orthopedic conditions limiting mobilization. * Severe cognitive impairment. * Hemodynamic instability. * Contraindications to mobilization or exercise. * Inability to complete at least two days of the preoperative physiotherapy program.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospital Length of Stay | From surgery until hospital discharge (approximately 7-14 days) | Postoperative hospital length of stay, defined as the number of days from surgery until hospital discharge. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intensive Care Unit Length of Stay | From surgery until discharge from the intensive care unit (approximately 1-5 days) | Length of stay in the intensive care unit, measured in days from admission to discharge from the intensive care unit. |
| Hemoglobin | Baseline (preoperative), through hospital discharge (up to approximately 30 days after surgery), and 7-10 days after hospital discharge. | Hemoglobin concentration measured as part of routine clinical laboratory testing and expressed in grams per deciliter (g/dL). |
| C-Reactive Protein (CRP) | Baseline (preoperative), through hospital discharge (up to approximately 30 days after surgery), and 7-10 days after hospital discharge. | Serum C-reactive protein concentration measured as part of routine clinical laboratory testing and expressed in milligrams per liter (mg/L) to assess postoperative inflammatory response. |
| Neutrophil-to-Lymphocyte Ratio (NLR) | Baseline (preoperative), through hospital discharge (up to approximately 30 days after surgery), and 7-10 days after hospital discharge. | Neutrophil-to-lymphocyte ratio calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The NLR is a unitless index used to assess systemic inflammatory response. |
| Dyspnea | At the first postoperative physiotherapy session on the surgical ward and at the final physiotherapy session before hospital discharge. | Dyspnea assessed using the Modified Borg Dyspnea Scale (0-10), with higher scores indicating greater perceived breathlessness. |
| Fatigue | At the first postoperative physiotherapy session on the surgical ward and at the final physiotherapy session before hospital discharge. | Fatigue assessed using the Modified Borg Fatigue Scale (0-10), with higher scores indicating greater perceived fatigue. |
Countries
Turkey (Türkiye)
Contacts
CONTACTFuat Gökdemir, PT, MSc
CONTACTAyşe Sena Manzak Dursun, PT, PhD
Outcome results
None listed