Cor Vasa 2006, 48(9):312-316 | DOI: 10.33678/cor.2006.102

Early spa rehabilitation of patients after cardiac surgical procedures

Ivan Karel^*, Libuše Bukatová, Jaroslav Zeleňák, Milan Adámek, Mária Princová, Martina Barátová

Lázně Poděbrady, a. s., Poděbrady, Česká republika

Introduction and methods:
Early rehabilitation of patients undergoing cardiac surgery follows directly upon their stay at a cardiac surgery department. After baseline assessment by a cardiologist, patients are admitted to the Early Rehabilitation Center (an analogy to the intensive care unit) where they stay for 1-7 days depending on their health condition and complications, and where rehabilitation is already started. At the beginning of their stay (about post-operative day 10) and prior to discharge from rehabilitation, patients are assessed using spirometry and echocardiography as well as exercise
testing. These examinations provide the basis for training sessions using a stationary bicycle, in a gym, and walking in circles, along with balneotherapy (massages, respiratory rehabilitation, inhalations, electrotherapy, baths). Ambulatory EKG and blood pressure monitoring are used, while the patients demographic data, type of surgery, procedure complications, and composition of drugs are also recorded. Overall, this method of management was employed in 1,214 men and women with a mean age of 66 years (range, 21-86). On average, patients were transferred from a cardiac surgery department on
post-operative day 8. Our group included 380 patients with diabetes (31%), 230 smokers (19%), with a body mass index of 27.7 (16-42.8 kg/m2, and a mean left ventricular ejection fraction of 52% (20-75%).

Results:
Stay at spa was associated with an increase in exercise testing tolerance by 16% (from 74 W to 86 W; p < 0.0001), improvement in forced vital capacity (FVC) by 14% (from 59% to 67%; p < 0.0001), and an increase in forced expiratory volume (FEV1) by 18% from 62% to 73%; p < 0.0001. Stay at spa was prematurely discontinued in 94 patients (8%). Of these four died, two of myocardial infarction, one of pulmonary embolism and one patient with alcoholic cardiomyopathy died a sudden death. Spa stay of 29 patients was discontinued because of non-cooperation, and for health reasons in the remaining 61: heart failure (5 patients), arrhythmia (4), stroke (4), myocardial infarction (2), infectious endocarditis (2), hemopericardium (1), hemothorax (1), poor sternum healing (9), poor healing of post-operative wounds in the lower limbs (3), anemization (3), enterorrhagy (3), bronchopneumonia (1), lower limb phlebothrombosis (3), and pulmonary embolism (1). Other health reasons required termination of the stay in 19 patients.

Conclusion:
When adhering to all contraindications and current guidelines, early spa rehabilitation following cardiac surgery is a safe method speeding up return of patients to work and their resumption of everyday activities. Early spa
rehabilitation makes sickness leave appreciably shorter, while reducing the need for health care in the post-operative period and thereafter.

Keywords: Cardiac surgery; Early spa cardiac rehabilitation

Published: September 1, 2006  Show citation