Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonantyo, Hitachi, Ibaraki, 317-0077, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Gen Thorac Cardiovasc Surg. 2022 Aug;70(8):721-729. doi: 10.1007/s11748-022-01786-7. Epub 2022 Feb 19.
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.
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.
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.
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.
主动脉手术后立即进行运动存在争议，相关证据有限。本研究旨在评估主动脉手术后 3 天内开始早期康复是否比常规护理更能改善患者出院时的身体功能。
我们使用了日本诊断程序组合数据库，这是一个全国性的住院患者数据库，涵盖了日本 1600 多家急性护理医院中的约 75%的重症监护病房（ICU）床位。我们确定了 2010 年 7 月至 2018 年 3 月期间接受开放或血管内主动脉手术并入住 ICU 的患者。主动脉手术后 3 天内开始康复的患者被定义为早期康复组，其余患者为常规护理组。我们使用逆概率治疗加权分析比较两组的结果。
在 121024 名符合条件的患者中，早期康复组有 44746 名（37.0%），常规护理组有 76278 名（63.0%）。在逆概率治疗加权分析中，早期康复组出院时的巴氏指数评分明显高于常规护理组（差值为 4.0；95%置信区间为 2.8-5.2）。早期康复组的院内死亡率、总住院费用、ICU 住院时间和住院时间均明显低于常规护理组。
主动脉手术后 3 天内进行早期康复与出院时身体功能的改善、ICU 和住院时间的缩短以及住院费用的降低有关，且不会增加死亡率。
