Impact of Delayed Postoperative Rehabilitation on Patients with Valvular Heart Disease: A Retrospective Cohort Study.

Abstract

Objectives: Delayed initiation of postoperative rehabilitation may be detrimental for improving everyday activities in postoperative patients with valvular heart disease. Rehabilitation is essential for postoperative valvular heart disease; however, the effective starting time of rehabilitation is unknown. This study aimed to investigate whether a delay in postoperative rehabilitation affects outcomes in patients after waiting for surgery for valvular heart disease.

Methods: Data from the JMDC database were extracted for 4330 patients diagnosed with valvular heart disease and who underwent surgery within 5 days of admission. Patient characteristics were compared between the usual rehabilitation group (started rehabilitation within 2 days postoperatively) and the delayed rehabilitation group (started rehabilitation at 3-5 days postoperatively). The primary outcome was hospitalization-associated disability (HAD); that is, the proportion of patients who showed a decline in the Barthel Index during hospitalization. Barthel Index at discharge, pulmonary complications following hospitalization, and postoperative complications were the secondary outcomes. Outcomes were compared in the usual and delayed rehabilitation groups after propensity score matching.

Results: Of the 4330 patients, 3845 patients were assigned to the usual rehabilitation group, and 485 patients were assigned to the delayed rehabilitation group. After propensity score matching, statistical analysis was performed on the usual and delayed rehabilitation groups, which each contained 418 patients. The delayed rehabilitation group had significantly higher rates of HAD (10.5% vs 8.1%) and respiratory complications (14.8% vs 11.2%) than the usual rehabilitation group.

Conclusions: Delayed postoperative rehabilitation may be associated with poor prognosis in patients with valvular heart disease.