ABSTRACT
Objective: Frailty has been noticed as an important preoperative risk factor for cardiac surgery. The purpose of this study was to evaluate the effect of frailty on the rehabilitation process and walking ability after cardiac surgery. Methods: A total of 213 patients aged 65 years or older who underwent elective cardiac surgery at our hospital between August 2018 and October 2020 and who underwent a preoperative frailty assessment were included. The patients were divided into two groups: group F with frailty and group N without frailty, and the perioperative factors, postoperative course, and walking ability in both groups were examined. Results: Of all patients, 70 (33%) were diagnosed as frail. In the preoperative factors, gait speed and grip strength were significantly lower in group F, and there were more cases of sarcopenia and malnutrition. There was no significant difference in surgical factors between the two groups, except for a bias in the surgical category. In the postoperative course, there were no significant differences in intubation time, ICU stay, postoperative complications, or hospital stay between the two groups, but more patients in group F were transferred to another hospital. In the F group, the start of walking and the day of achieving 100 m walking were significantly delayed, and the number of patients who achieved 300 m walking was 52 (74%), which was significantly lower than 197 (89%) in the N group. The cutoff value of gait speed was 0.88 m/s. Conclusions: Frailty was associated with delayed rehabilitation and reduced walking ability after cardiac surgery, and increased hospital transfers. In addition, the preoperative gait speed was adopted as one of the factors related to the possibility of a 300 m walk after surgery. We believe that preoperative rehabilitation is a promising strategy to improve the condition of frail patients who require cardiac surgery.
ABSTRACT
Perioperative hyperglycemia, hypoglycemia, and high glycemic variability are independent risk factors for mortality in critically ill patients. After cardiac surgery, intensive glycemic control without hypoglycemia may help to reduce the number of adverse events; however, postoperative glycemic control is difficult in many cases. In this study, we investigated whether the bedside artificial pancreas STG-55 is useful for postoperative glycemic control in cardiac surgery. METHODS: In the present single-center retrospective study, we analyzed arterial blood glucose levels for 15 h after surgery in 69 patients treated using the bedside artificial pancreas and in 160 patients treated with continuous intravenous insulin infusion using a scale that adjusts for current blood glucose level, glycemic fluctuation, and insulin dose. RESULTS: Hypoglycemia (arterial blood glucose level < 70 mg/dL) was not observed in any case. Patients in the group treated using the bedside artificial pancreas showed lower mean, maximum, and minimum blood glucose levels and glycemic variability and shorter treatment duration in the intensive care unit than patients treated with continuous intravenous insulin infusion. Notably, these results were not affected by diabetes status or differences in operative procedures. Analysis of patients undergoing isolated coronary artery bypass grafting surgery revealed that the incidence of surgical site complications composite with infection and dehiscence was lower. CONCLUSIONS: In cardiac surgery, postoperative treatment using bedside artificial pancreas is a novel therapy that improves hyperglycemia and glycemic variability, without hypoglycemia, and is, therefore, an attractive strategy for future surgeries.
