Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 8/2022

19-02-2022 | Aortic Aneurysm | Original Article

Effectiveness of early rehabilitation following aortic surgery: a nationwide inpatient database study

Authors: Kensuke Nakamura, Hiroyuki Ohbe, Kazuaki Uda, Hiroki Matsui, Hideo Yasunaga

Published in: General Thoracic and Cardiovascular Surgery | Issue 8/2022

Login to get access

Abstract

Objective

Exercise immediately after aortic surgery is controversial with limited evidence. The present study aimed to assess whether early rehabilitation commencing within 3 days of aortic surgery improves physical functions at discharge more than usual care in patients after aortic surgery.

Methods

We used the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database from more than 1600 acute care hospitals that covers approximately 75% of all intensive care unit (ICU) beds in Japan. We identified patients who underwent open or endovascular aortic surgery and were admitted to the ICU between July 2010 and March 2018. Patients beginning rehabilitation within 3 days of aortic surgery were defined as the early rehabilitation group and the remaining patients as the usual care group. We used inverse probability of treatment weighting analyses to compare outcomes between the two groups.

Results

Among 121,024 eligible patients, there were 44,746 (37.0%) in the early rehabilitation group and 76,278 (63.0%) in the usual care group. In inverse probability of treatment weighting analyses, Barthel index scores at discharge were significantly higher in the early rehabilitation group than in the usual care group (difference, 4.0; 95% confidence interval, 2.8–5.2). The early rehabilitation group had significantly lower in-hospital mortality, lower total hospitalization costs, shorter ICU stay, and shorter hospital stay than the usual care group.

Conclusion

Early rehabilitation within 3 days of aortic surgery was associated with improved physical functions at discharge, shorter ICU and hospital stays, and lower hospitalization costs without increased mortality.
Appendix
Available only for authorised users
Literature
1.
Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13):e266-369.PubMed
2.
Salzwedel A, Jensen K, Rauch B, Doherty P, Metzendorf MI, Hackbusch M, et al. Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: update of the Cardiac Rehabilitation Outcome Study (CROS-II). Eur J Prev Cardiol. 2020;27(16):1756–74.PubMedPubMedCentralCrossRef
3.
Jordão MT, Ladd FV, Coppi AA, Chopard RP, Michelini LC. Exercise training restores hypertension-induced changes in the elastic tissue of the thoracic aorta. J Vasc Res. 2011;48(6):513–24.PubMedCrossRef
4.
Les AS, Shadden SC, Figueroa CA, Park JM, Tedesco MM, Herfkens RJ, et al. Quantification of hemodynamics in abdominal aortic aneurysms during rest and exercise using magnetic resonance imaging and computational fluid dynamics. Ann Biomed Eng. 2010;38(4):1288–313.PubMedPubMedCentralCrossRef
5.
Bailey TG, Perissiou M, Windsor MT, Schulze K, Nam M, Magee R, et al. Effects of acute exercise on endothelial function in patients with abdominal aortic aneurysm. Am J Physiol Heart Circ Physiol. 2018;314(1):H19–30.PubMedCrossRef
6.
Chaddha A, Eagle KA, Braverman AC, Kline-Rogers E, Hirsch AT, Brook R, Jackson EA, Woznicki EM, Housholder-Hughes S, Pitler L, et al. Exercise and physical activity for the post-aortic dissection patient: the clinician’s conundrum. Clin Cardiol. 2015;38(11):647–51.PubMedPubMedCentralCrossRef
7.
Spanos K, Tsilimparis N, Kölbel T. Exercise after aortic dissection: to run or not to run. Eur J Vasc Endovasc Surg. 2018;55(6):755–6.PubMedCrossRef
8.
Chaddha A, Kline-Rogers E, Woznicki EM, Brook R, Housholder-Hughes S, Braverman AC, et al. Cardiology patient page. Activity recommendations for postaortic dissection patients. Circulation. 2014;130(16):e140-142.PubMedCrossRef
9.
Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873–926.PubMedCrossRef
10.
Corone S, Iliou MC, Pierre B, Feige JM, Odjinkem D, Farrokhi T, et al. French registry of cases of type I acute aortic dissection admitted to a cardiac rehabilitation center after surgery. Eur J Cardiovasc Prev Rehabil. 2009;16(1):91–5.PubMedCrossRef
11.
Delsart P, Maldonado-Kauffmann P, Bic M, Boudghene-Stambouli F, Sobocinski J, Juthier F, et al. Post aortic dissection: gap between activity recommendation and real life patients aerobic capacities. Int J Cardiol. 2016;219:271–6.PubMedCrossRef
12.
Fuglsang S, Heiberg J, Hjortdal VE, Laustsen S. Exercise-based cardiac rehabilitation in surgically treated type-A aortic dissection patients. Scand Cardiovasc J. 2017;51(2):99–105.PubMedCrossRef
13.
Hornsby WE, Norton EL, Fink S, Saberi S, Wu X, McGowan CL, et al. Cardiopulmonary exercise testing following open repair for a proximal thoracic aortic aneurysm or dissection. J Cardiopulm Rehabil Prev. 2020;40(2):108–15.PubMedPubMedCentralCrossRef
14.
Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2020;2020:2047487320913379.
15.
Schwaab B, Rauch B, Völler H, Benzer W, Schmid JP. Beyond randomised studies: recommendations for cardiac rehabilitation following repair of thoracic aortic aneurysm or dissection. Eur J Prev Cardiol. 2020;28:e17–9.CrossRef
16.
Fuke R, Hifumi T, Kondo Y, Hatakeyama J, Takei T, Yamakawa K, et al. Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis. BMJ Open. 2018;8(5):e019998.PubMedPubMedCentralCrossRef
17.
18.
Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013;41(6):1543–54.PubMedCrossRef
19.
Inoue T, Ichihara T, Sakaguchi H, Kanamori T. Early rehabilitation program in uncomplicated Stanford type B acute aortic dissection. Kyobu Geka. 2014;67(9):781–8.PubMed
20.
Hideo Y. Real world data in Japan: chapter II the diagnosis procedure combination database. Ann Clin Epidemiol. 2019;1(3):76–9.CrossRef
21.
Ohbe H, Sasabuchi Y, Kumazawa R, Matsui H, Yasunaga H. Intensive care unit occupancy in Japan, 2015–2018: a nationwide inpatient database study. J Epidemiol 2021.
22.
Yamana H, Moriwaki M, Horiguchi H, Kodan M, Fushimi K, Yasunaga H. Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol. 2017;27(10):476–82.PubMedPubMedCentralCrossRef
23.
Yagi M, Yasunaga H, Matsui H, Morita K, Fushimi K, Fujimoto M, et al. Impact of rehabilitation on outcomes in patients with ischemic stroke: a nationwide retrospective cohort study in Japan. Stroke. 2017;48(3):740–6.PubMedCrossRef
24.
Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965;14:61–5.PubMed
25.
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874–82.PubMedCrossRef
26.
Shigematsu K, Nakano H, Watanabe Y. The eye response test alone is sufficient to predict stroke outcome–reintroduction of Japan Coma Scale: a cohort study. BMJ Open. 2013;3(4):e002736.PubMedPubMedCentralCrossRef
27.
Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–82.PubMedCrossRef
28.
Rubin D, Schenker N. Multiple imputation in healthcare databases: an overview and some applications. Stat Med. 1991;10(4):14.CrossRef
29.
Aloisio KM, Swanson SA, Micali N, Field A, Horton NJ. Analysis of partially observed clustered data using generalized estimating equations and multiple imputation. Stata J. 2014;14(4):863–83.PubMedPubMedCentralCrossRef
30.
Rosenbaum P, Rubin D. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat. 1985;39:1.
31.
Griswold ME, Localio AR, Mulrow C. Propensity score adjustment with multilevel data: setting your sites on decreasing selection bias. Ann Intern Med. 2010;152(6):393–5.PubMedCrossRef
32.
33.
Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28(25):3083–107.PubMedPubMedCentralCrossRef
34.
Fenton C, Tan AR, Abaraogu UO, McCaslin JE. Prehabilitation exercise therapy before elective abdominal aortic aneurysm repair. Cochrane Database Syst Rev. 2021;7:CD013662.PubMed
35.
Chen S, Su CL, Wu YT, Wang LY, Wu CP, Wu HD, Chiang LL. Physical training is beneficial to functional status and survival in patients with prolonged mechanical ventilation. J Formos Med Assoc. 2011;110(9):572–9.PubMedCrossRef
36.
Aitken SJ, Naganathan V, Blyth FM. Aortic aneurysm trials in octogenarians: are we really measuring the outcomes that matter? Vascular. 2016;24(4):435–45.PubMedCrossRef
37.
Jönsson M, Berg SK, Missel M, Palm P. Am I going to die now? Experiences of hospitalisation and subsequent life after being diagnosed with aortic dissection. Scand J Caring Sci. 2020;35(3):929–36.PubMedCrossRef
38.
Nydahl P, Sricharoenchai T, Chandra S, Kundt FS, Huang M, Fischill M, et al. Safety of patient mobilization and rehabilitation in the intensive care unit systematic review with meta-analysis. Ann Am Thorac Soc. 2017;14(5):766–77.PubMedCrossRef
39.
Nakayama A, Morita H, Komuro I. Comprehensive cardiac rehabilitation as a therapeutic strategy for abdominal aortic aneurysm. Circ Rep. 2019;1(11):474–80.PubMedPubMedCentralCrossRef
40.
Oliveira R, Nakajima E, de Vasconcelos VT, Riera R, Baptista-Silva JCC. Effectiveness and safety of structured exercise vs no exercise for asymptomatic aortic aneurysm: systematic review and meta-analysis. J Vasc Bras. 2020;19:e20190086.PubMedPubMedCentralCrossRef
41.
Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271–81.PubMedCrossRef
42.
Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658.PubMedPubMedCentralCrossRef
43.
Kakutani N, Fukushima A, Kinugawa S, Yokota T, Oikawa T, Nishikawa M, et al. Progressive mobilization program for patients with acute heart failure reduces hospital stay and improves clinical outcome. Circ Rep. 2019;1(3):123–30.PubMedPubMedCentralCrossRef
Metadata
Title
Effectiveness of early rehabilitation following aortic surgery: a nationwide inpatient database study
Authors
Kensuke Nakamura
Hiroyuki Ohbe
Kazuaki Uda
Hiroki Matsui
Hideo Yasunaga
Publication date
19-02-2022
Publisher
Springer Nature Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 8/2022
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-022-01786-7

Other articles of this Issue 8/2022

General Thoracic and Cardiovascular Surgery 8/2022 Go to the issue

Original Article

Immunocompetent cells in durable ventricular assist device-implanted non-ischaemic dilated cardiomyopathy

Original Article

Hyperlactatemia as a prognostic indicator for contemporary left ventricular assist device implantation

Original Article

Prognostic analysis and clinical characteristics of dual primary lung cancer: a population study based on surveillance, epidemiology, and end results (SEER) database

How to Do It

Hybrid robotic lobectomy with thoracic wall resection for superior sulcus tumor

Case Report

Successful bridge to transplantation with long-term support using Berlin heart EXCOR in a child with failing Fontan

Original Article

Control of air leakage during pleurectomy/decortication by the ventilation and anchoring method