Postoperative Care for Patients After Coronary Artery Bypass Grafting (CABG) Surgery
Cardiovascular Monitoring
- The American College of Cardiology recommends continuous electrocardiographic monitoring for arrhythmias for at least 48 hours in all patients after CABG, as post-CABG atrial fibrillation most commonly occurs between days 2 and 4 after surgery 1, 2, 3
- Continuous ST-segment monitoring for detection of ischemia is reasonable in the intraoperative period and may be considered in the early postoperative period to detect myocardial ischemia 1, 3
- Pulmonary artery catheter placement is indicated in patients with cardiogenic shock and can be useful in patients with acute hemodynamic instability 1, 2, 4
- Beta blockers should be reinstituted as soon as possible after CABG in all patients without contraindications to reduce the incidence of postoperative atrial fibrillation 3, 5
Respiratory Monitoring
- Early postoperative extubation and accelerated recovery should be targeted for low to medium-risk patients undergoing uncomplicated CABG 6, 7
Wound and Infection Monitoring
- Aggressive control of perioperative hyperglycemia with continuous intravenous insulin to maintain blood glucose ≤180 mg/dL is indicated to reduce the risk of deep sternal wound infections 5, 8
- Preoperative antibiotic administration should be used in all patients to reduce the risk of postoperative infection 8
Neurological Monitoring
- Monitor for signs of stroke or neurological complications, particularly in high-risk patients (age >65 years, left main coronary stenosis, peripheral artery disease, history of cerebrovascular disease, hypertension, smoking, and diabetes mellitus) 1, 2
Psychological Monitoring
- Assess for signs of depression and anxiety, which are common after CABG and associated with poorer outcomes 3
- Cognitive behavior therapy or collaborative care for patients with clinical depression after CABG can be beneficial 1, 3, 9
Medication Management
- Aspirin is the drug of choice for prophylaxis against early saphenous vein graft closure and should be continued indefinitely 8
- ACE inhibitors and angiotensin-receptor blockers given before CABG are recommended to be continued 1, 3
- For patients with post-CABG atrial fibrillation that persists more than 24 hours, warfarin anticoagulation for 4 weeks is probably indicated 10
Rehabilitation and Recovery
- Cardiac rehabilitation is recommended for all eligible patients after CABG 9
- Provide education and support regarding smoking cessation for all smokers 1, 8, 3