居家物理治疗方案可减少心脏手术患者的住院时间和费用。一项回顾性队列研究。

Home-Based Physiotherapy Programme Reduces Hospital Stay and Costs in Cardiac Surgery. A Retrospective Cohort Study.

作者信息

Montero-Cámara Jorge, Ferrer-Sargues Francisco José, Peredo David Cuesta, Cabello Adrián Sarria, Rovira María José Segrera, Calabuig Juan Antonio Margarit, Valtueña-Gimeno Noemí, Pardo Juan, Sánchez-Sánchez María Luz

机构信息

Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.

Hospital Universitario de la Ribera, Valencia, Spain.

出版信息

Physiother Res Int. 2025 Apr;30(2):e70032. doi: 10.1002/pri.70032.

DOI:10.1002/pri.70032

PMID:39983054

Abstract

BACKGROUND AND PURPOSE

Cardiac surgery enhances cardiovascular disease (CVD) patient survival rates, and the fast-track protocol can reduce complications, hospital length of stay (HLOS) and associated costs. However, there is no evidence on the effectiveness of unsupervised physiotherapy programmes in reducing HLOS and postoperative pulmonary complications in patients undergoing fast-track surgery. The study aimed to determine if a pre-surgical respiratory programme reduces intensive care unit length of stay (ICULOS) and HLOS patients undergoing fast-track surgery, and its effects on post-operative complications and healthcare costs.

METHODS

This was a retrospective observational cohort study. The patients were divided into two groups: those who followed the exercise programme (pre-hab group) and those who did not (no pre-hab group). The study analysed the mean of ICULOS and HLOS for each group, recorded post-operative complications, and calculated healthcare costs using the Spanish Ministry of Health cost tables.

RESULTS

A total of 418 patients participated in the study with a mean age of 70.44 (10.87) years. The study found significant differences in HLOS (p = 0.001) and ICULOS (p = 0.003) between groups. Pre-hab HLOS was 232.8 (221.3) hours in the hospital, whereas no pre-hab LOS increased to 315.1 (277.9) hours. Pre-hab ICULOS was 82.0 (129.8) hours when No pre-hab ICULOS accounted 120.2 (190.3) hours. This reduction in hospital admissions resulted in savings of €356,107.16 in average healthcare costs for the pre-hab group. Mortality risk (p = 0.034) was also reduced in the pre-hab group (17.7% vs. 26.65% in the no pre-hab group).

DISCUSSION

An unsupervised home-based respiratory programme reduces hospital and ICU stay, healthcare costs, post-surgical pulmonary complications, and mortality risk. The clinical application of an unsupervised home-based pre-habilitation programme, focussing on ventilatory exercises and costal expansion techniques, has proven effective in enhancing patient recovery post-cardiac surgery, offering significant healthcare cost savings, and reducing the burden on hospital resources.

摘要

背景与目的

心脏手术可提高心血管疾病（CVD）患者的生存率，快速康复方案可减少并发症、缩短住院时间（HLOS）并降低相关费用。然而，尚无证据表明无监督物理治疗方案对接受快速康复手术患者的住院时间和术后肺部并发症的有效性。本研究旨在确定术前呼吸训练方案是否能缩短接受快速康复手术患者的重症监护病房住院时间（ICULOS）和住院时间，并评估其对术后并发症和医疗费用的影响。

方法

这是一项回顾性观察队列研究。患者分为两组：遵循运动训练方案的患者（术前康复组）和未遵循该方案的患者（无术前康复组）。该研究分析了每组患者的ICULOS和HLOS均值，记录术后并发症，并使用西班牙卫生部成本表计算医疗费用。

结果

共有418例患者参与本研究，平均年龄为70.44（10.87）岁。该研究发现两组患者在HLOS（p = 0.001）和ICULOS（p = 0.003）方面存在显著差异。术前康复组的住院时间为232.8（221.3）小时，而无术前康复组的住院时间增加到315.1（277.9）小时。术前康复组的ICULOS为82.0（129.8）小时，而无术前康复组的ICULOS为120.2（190.3）小时。住院天数的减少使术前康复组的平均医疗费用节省了356,107.16欧元。术前康复组的死亡风险（p = 0.034）也有所降低（17.7% 对比无术前康复组的26.65%）。