ABSTRACT
INTRODUCTION: Preoperative nursing care affects many factors such as reducing the length of hospital stay of the patients in the perioperative period, the rate of postoperative complications, the duration of the operation, decrease of postoperative pain level and early mobilization. AIMS: We aimed to determine the effect of preoperative evidence-based care education that given to cardiac surgery clinical nurses on the postoperative recovery of patients. METHODS: The research was planned as quasi-experimental. Eighty-six patients who underwent cardiovascular surgery were divided into control and intervention groups. First, the ongoing preoperative care practices and patient recovery outcomes of the clinic were recorded for the control group data. Second, education was provided for the clinical nurses about the preoperative evidence-based care list, and a pilot application was implemented. Finally, the evidence-based care list was applied by the nurses to the intervention group, and its effects on patient outcomes were evaluated. The data were collected using the preoperative evidence-based care list, descriptive information form, intraoperative information form and postoperative patient evaluation form. RESULTS: The evidence-based care list was applied to the patients in the intervention group, with 100% adherence by the nurses. All pain level measurements in the intervention group were significantly lower in all measurements (p = .00). The body temperature measurements (two measurements) of the intervention group were higher (p = .00). The postoperative hospital stays of the control group and the intervention group were 11.21 ± 8.41 and 9.50 ± 3.61 days. CONCLUSION: The presented preoperative evidence-based care list can be used safely in nursing practices for patients. It provides effective normothermia, reduces the level of pain, shortens the hospital stay and reduces the number of postoperative complications. RELEVANCE TO CLINICAL PRACTICE: By applying a preoperative evidence-based care to patients undergoing cardiac surgery, pain levels, hospital stays and the number of complications decrease, and it is possible to maintain normothermia. An evidence-based care can be used to ensure rapid postoperative recovery for patients undergoing cardiac surgery.
ABSTRACT
Abstract Objective: To evaluate the clinical impact of coronary dominance type in terms of early and long-term outcomes in patients undergoing elective coronary artery bypass grafting (CABG). Methods: A total of 844 consecutive patients who underwent elective CABG were divided into two groups based on preoperative angiographic views as left dominant (LD) and right dominant or co-dominant (RD+CD). The measured outcomes were postoperative complications, 30-day mortality, long-term mortality, and major adverse cardiac and cerebrovascular events (MACCE). Results: RD+CD was present in 87.9% (n=742) and LD in 12.1% (n=102) of patients. Postoperative complications, 30-day mortality, and 30-day readmissions were similar in both groups. The median duration of follow-up was 3.4 years. LD was not an independent predictor of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI] 0.89-2.45, P=0.12), but it was an independent predictor of MACCE in the long term (adjusted HR 2.18, 95% CI 1.39-3.42, P=0.001). Conclusion: In patients undergoing elective surgical revascularization, left coronary dominance is associated with increased MACCE risk in the long term. Therefore, the assessment of coronary dominance type should be an integral part of outpatient management after CABG.