IMR Press / RCM / Volume 23 / Issue 2 / DOI: 10.31083/j.rcm2302077
Open Access Original Research
Physical function examination at intensive care unit as predictive indicators for hospitalization-associated disability in patients after cardiovascular surgery
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1 Department of Rehabilitation, Sakakibara Heart Institute, 183-0003 Tokyo, Japan
2 Department of Cardiology, Sakakibara Heart Institute, 183-0003 Tokyo, Japan
3 Department of Physical Therapy, Faculty of Health Science, Juntendo University, 113-0033 Tokyo, Japan
4 Department of Cardiovascular Surgery, Sakakibara Heart Institute, 183-0003 Tokyo, Japan
5 Department of Cardiovascular Surgery, Teikyo University Hospital, 173-8606 Tokyo, Japan
6 Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, 212-0014 Kanagawa, Japan
7 Division of Intensive Care Unit, Sakakibara Heart Institute, 183-0003 Tokyo, Japan
8 Sakakibara Heart Institute, 183-0003 Tokyo, Japan
*Correspondence: atsukonakanaka@gmail.com (Atsuko Nakayama)
Academic Editors: Kazuhiro P. Izawa and Peter H. Brubaker
Rev. Cardiovasc. Med. 2022, 23(2), 77; https://doi.org/10.31083/j.rcm2302077
Submitted: 16 November 2021 | Revised: 18 December 2021 | Accepted: 27 December 2021 | Published: 22 February 2022
(This article belongs to the Special Issue Cardiac rehabilitation)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Following cardiovascular surgery, patients are at high risk of requiring systemic management in the intensive care unit (ICU), resulting in hospitalization-associated disability (HAD). Predicting the risk of HAD during the postoperative course is important to prevent susceptibility to cardiovascular events. Assessment of physical function during the ICU stay may be useful as a prediction index but has not been established. Methods: This prospective observational study conducted at a high-volume cardiovascular center included 236 patients (34% female; median age, 73 years) who required an ICU stay of at least 72 hours after surgery and underwent postoperative rehabilitation. HAD was defined as a decrease in the discharge Barthel index (BI) score of at least 5 points relative to the preadmission BI score. Physical Function ICU Test-scored (PFIT-s), Functional Status Score for the ICU (FSS-ICU), and Medical Research Council (MRC)-sumscore were used to assess physical function at ICU discharge. Results: HAD occurred in 58 (24.6%) of the 236 patients following cardiovascular surgery. The cut-off points for HAD were 7.5 points for the PFIT-s (sensitivity 0.80, specificity 0.59), 24.5 points for the FSS-ICU (sensitivity 0.57, specificity 0.66), and 59.5 points for the MRC-sumscore (sensitivity 0.93, specificity 0.66). Multivariate logistic regression analysis revealed a PFIT-s of >7.5 points (odds ratio [OR], 4.84; 95% CI, 2.39–9.80; p < 0.001) and an MRC-sumscore of >59.5 points (OR, 2.43; 95% CI, 1.22–4.87; p = 0.012) as independent associated factors. Conclusions: We demonstrate that the PFIT-s and MRC-sumscore at ICU discharge may be helpful as a predictive indicator for HAD in patients having undergone major cardiovascular surgery.

Keywords
hospitalization-associated disability
physical function assessment
intensive care unit
cardiovascular surgery
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