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العنوان
Factors Affecting Post Open-Heart surgery outcomes for Hospitalized patients /
المؤلف
Elsaed,Mohamed Mousa.
هيئة الاعداد
باحث / Mohamed Mousa Elsaed
مشرف / Asmaa Hamdi Mohamed
مشرف / Mona Nadr Ebrahim
تاريخ النشر
2019
عدد الصفحات
223p.;
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
تمريض العناية الحرجة
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية التمريض - تمريض الحالات الحرجة
الفهرس
Only 14 pages are availabe for public view

from 223

from 223

Abstract

Open-heart surgery plays an important role in the management of cardiovascular diseases and encompasses the care of a patient with greater acuity and complexity. Cardiac surgery, including coronary artery bypass grafting (CABG) and vavular surgery represent the most common classes of surgical procedure performed globally (Abdallah, 2012).
Aim of the Study This study aims to assess factors affecting patients‘ outcomes post open-heart surgery during hospitalization through:
4. Assessing patients‘ demographic and medical data
5. Identifying factors that may affect open-heart surgery outcomes during hospitalization.
6. Assessing patients‘ knowledge and practices regarding self care post open-heart surgery.
Research question
The aims of this study have been achieved through answering the following question:
What are the factors affecting post open-heart surgery outcomes for hospitalized patients? Research Design: A descriptive explanatory research design was selected to fulfill the aim of the study and answer the research question. Research Setting: The study was conducted at Post Cardiothoracic surgery ICU at Cardiothoracic and Vascular Surgery Hospital affiliated to Ain Shams University Hospitals. Subjects: A convenient sample included 120 patients in post open-heart surgery from the previously mentioned setting.
Tools for data collection:
Data were collected using the following tools:
I: Patients’ assessment questionnaire: (Appendix II)
It was designed by the researcher in Arabic language after reviewing the recent and related literatures to assess patients’ demographic and medical history data.
II: Open-heart surgery assessment questionnaire: (Appendix III)
This questionnaire was developed by the researcher after reviewing the recent related literatures to assess the preoperative, intraoperative and postoperative factors affecting the patients’ outcomes post open heart surgery during hospitalization.
III: European system for cardiac operative risk evaluation (EURO score II): (Appendix IV)
This tool is adopted from the European Association for Cardiothoracic Surgery (2011) for assessment the factors affecting post open-heart surgery outcomes. It was designed to categorize open heart surgery risk evaluation. It was categorized as low risk, moderate risk and high risk for death.
IV: Patient’s self-care knowledge assessment questionnaire: (Appendix V)
This questionnaire was developed by the researcher in Arabic language based on reviewing the recent related recent literature to assess patients‘ knowledge about self-care after open-heart surgery regarding nutrition, drugs, daily living activates, wound care and warning signs.
V: Patient’s self-care practice observational checklist: (Appendix VI)
This checklist was developed by the researcher based on reviewing the recent related literature to assess patients‘ self-care practices regarding deep breathing exercises,cough exercises, spirometer exercises, shoulder exercises, trunk exercises and arm exercises. Results: Findings of the current study can be summarized as the following:  According to current study, 40 % of patients under study were between the age group 50 to less than 60 years, 73.3 % of them were males, 59.2 % of them had university level of education, and 60 % lived in urban areas.
 Also, 70 % of the studied patients were over-weight, 85 % of them had HTN, 83.3 % had DM and 65 % of were smokers
 Concerning outcomes of patients under study, the current study revealed that 79.2 % of the studied patients have been discharged on time, 12.5 % were hospitalized for a long time (more than 10 days) while 8.3 % of them were died.  Regarding preoperative factors affecting open heart surgery outcomes, 93.3 % of the studied patients had normal vital signs 24 hours pre-operatively and only 10 % of the studied patients had received pre-operative cardiac inotropic drugs. Regarding intraoperative factors affecting open heart surgery outcomes, 50 % of the studied patients had consumed from 5 to less than 7 hours during the operation, while only 1.7 % of them had cardiac arrest intra-operatively.  In addition, 75 % of the studied patients had stayed in the ICU less than 48 hours post-operatively and had been connected to mechanical ventilation for less than 6 hours postoperatively.
 In addition, 75 % of the studied patients were at low risk for death according to EURO Score II, 10 % of them were at moderate risk for death, while 15 % of them were at high risk for death.  Also, 96.7 % of the studied patients had total satisfactory level of self-care practices while 93.3 % of them had satisfactory level of knowledge.  There was no significant relation between all the demographic data (age, gender, level of education and residence) and post-operative outcomes at P > 0.05.  There were highly statistically significant relations between the studied patients’ post-operative outcomes and their pre-operative vital signs and use of inotropic drugs at P < 0.001. There was no significant relation between the studied patients’ post-operative outcomes and the time consumed during operation and use of cardiac assistive devices during operation at P > 0.05.  There were highly statistically significant relations between post-operative outcomes and patients post-operative vital signs, time of regaining consciousness post-operative, post-operative ICU stay, duration of post-operative mechanical ventilation, time of chest tube removal after surgery at P < 0.001.
Conclusion
According to the results of this study, it can be concluded that preoperative vital signs, use of preoperative cardiac inotroptic drugs and cardiac assistive devices, intraoperative use of cardiac inotroptic drugs in addition to postoperative vital signs, delay of regaining consciousness, postoperative ICU stay, duration of postoperative mechanical ventilation, time of chest tube removal and occurrence of postoperative complications; were the most significant factors affecting outcomes among patients under study.Recommendations
The result of this study projected the following recommendations:  Scheduled visits for assessment of the patients before the scheduled surgery to evaluate the health state and modify preoperative factors that could affect the outcomes.  Prepare booklets including information about the instructions from the preoperative preparations until postoperative rehabilitation.  Further studies will be needed to modify factors affecting outcomes and improve outcome of patients undergoing open heart surgery.