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

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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.

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Data availability statement

The datasets analyzed during the present study are not publicly available owing to contracts with the hospitals providing data to the database.

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Acknowledgements

Not applicable.

Funding

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (21AA2007 and 20AA2005) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907).

Author information

Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonantyo, Hitachi, Ibaraki, 317-0077, Japan

    Kensuke Nakamura

  2. 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

    Hiroyuki Ohbe, Kazuaki Uda, Hiroki Matsui & Hideo Yasunaga

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  1. Kensuke Nakamura
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Contributions

HO and KN contributed to conceptualization; HO, KU, and HM were involved in methodology, software, and formal analysis; HY collected resources; KU and HM performed data curation,; HO, KN, and HY were involved in writing and preparing the original draft of the manuscript, and writing, reviewing, and editing the manuscript; HO contributed to visualization; HY did supervision and funding acquisition; HO and KN were involved in project administration,. All the authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Hiroyuki Ohbe.

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Conflict of interest

The authors declare no conflicts of interest.

Institutional review board statement

This study was performed in accordance with the amended Declaration of Helsinki, and the Institutional Review Board of The University of Tokyo approved this study (approval number: 3501-(3); 25 December 2017).

Informed consent statement

Because the data were anonymous, the Institutional Review Board waived the requirement for informed consent. No information about individual patients, hospitals, or treating physicians was available.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplemental Figure 1. Patient characteristics for multiple imputation dataset (TIFF 562 KB)

11748_2022_1786_MOESM2_ESM.tiff

Supplemental Figure 2. Distribution of the propensity scores in the early rehabilitation and usual care groups. A: In the unweighted cohort, B: In the weighted cohort by inverse probability of treatment weighting analyses (TIFF 556 KB)

Supplementary file3 (DOCX 18 KB)

Supplementary file4 (DOCX 20 KB)

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Nakamura, K., Ohbe, H., Uda, K. et al. Effectiveness of early rehabilitation following aortic surgery: a nationwide inpatient database study. Gen Thorac Cardiovasc Surg 70, 721–729 (2022). https://doi.org/10.1007/s11748-022-01786-7

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  • DOI: https://doi.org/10.1007/s11748-022-01786-7

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