Our Summary

This study examined whether a different approach to post-surgery care for heart surgery patients could reduce their need for follow-up care without increasing their risk of complications. The study took place in a 600-bed hospital, and compared patients who underwent heart surgery in the 1.5 years before a new approach was implemented (627 patients) and after it was implemented (477 patients).

The new approach, dubbed “Keep Your Move in the Tube” (KMIT), encourages patients to be mindful of their movements and activities after surgery, using pain as a guide. This is in contrast to traditional post-surgery advice which typically restricts certain activities and movements to prevent damage to the surgical site.

The results showed that patients using the KMIT approach were three times more likely to be discharged to their own homes, rather than needing inpatient rehabilitation or care in a skilled nursing facility. They were also more likely to be able to move around and transfer themselves independently. Importantly, there was no increase in complications from the surgery or readmissions to the hospital within 30 days.

In simple terms, KMIT encourages patients to be more active and independent post-surgery, resulting in less need for expensive follow-up care without increasing the risk of complications or readmissions.

FAQs

  1. What is the “Keep Your Move in the Tube” (KMIT) approach to post-surgery care for heart surgery patients?
  2. How does the KMIT approach affect the need for follow-up care and risk of complications after heart surgery?
  3. Did the implementation of the KMIT approach result in any increased rates of complications or readmissions within 30 days post-surgery?

Doctor’s Tip

A doctor may tell a patient undergoing sternotomy to follow the “Keep Your Move in the Tube” approach after surgery to promote faster recovery and reduce the need for follow-up care. This approach encourages patients to be mindful of their movements and activities, using pain as a guide, and promotes independence in movement and transfers. By following this approach, patients may be more likely to be discharged to their own homes and have a smoother recovery process.

Suitable For

Patients who undergo heart surgery, specifically sternotomy (a surgical procedure in which a vertical incision is made along the sternum to access the heart), are typically recommended the new approach of “Keep Your Move in the Tube” (KMIT). This approach is especially beneficial for patients who are at a higher risk of needing inpatient rehabilitation or care in a skilled nursing facility after surgery.

Patients who may benefit from the KMIT approach include those who have undergone heart valve replacement, coronary artery bypass surgery, or other complex cardiac surgeries that require a sternotomy. These patients may have difficulty with mobility and independence post-surgery, and may benefit from the more active and mindful approach to post-surgery care provided by KMIT.

Overall, patients recommended for sternotomy are those who require open-heart surgery and have a higher risk of complications or extended recovery time. The KMIT approach can help these patients achieve better outcomes and reduce the need for costly follow-up care without increasing the risk of complications.

Timeline

Before sternotomy:

  1. Patient undergoes pre-operative evaluations and tests to assess their current health status.
  2. Patient is informed about the surgery and its potential risks and benefits.
  3. Patient is admitted to the hospital on the day of surgery.
  4. Patient undergoes sternotomy, which involves cutting through the breastbone to access the heart.
  5. Patient is monitored closely in the intensive care unit post-surgery to ensure stable recovery.

After sternotomy:

  1. Patient is gradually weaned off mechanical ventilation and pain medications.
  2. Patient is encouraged to start moving and performing breathing exercises to prevent complications such as pneumonia or blood clots.
  3. Patient may require physical therapy to regain strength and mobility.
  4. Patient is monitored for signs of infection, bleeding, or other complications.
  5. Patient is discharged from the hospital once stable and may require follow-up care with their cardiologist or primary care provider.
  6. Patient continues to recover at home and gradually resumes normal activities.

What to Ask Your Doctor

  1. What is a sternotomy and why is it performed?
  2. What are the potential complications or risks associated with a sternotomy?
  3. How long is the recovery period after a sternotomy surgery?
  4. What restrictions or limitations should I follow during my recovery?
  5. How can I manage pain and discomfort after a sternotomy?
  6. What physical activities or exercises are safe for me to do after surgery?
  7. What signs or symptoms should I watch out for that may indicate a complication?
  8. How often should I follow up with you after my sternotomy surgery?
  9. Are there any specific lifestyle changes or precautions I should take post-surgery?
  10. Can you explain the “Keep Your Move in the Tube” approach and how it may benefit me in my recovery process?

Reference

Authors: Gach R, Triano S, Ogola GO, da Graca B, Shannon J, El-Ansary D, Bilbrey T, Cortelli M, Adams J. Journal: PM R. 2021 Dec;13(12):1321-1330. doi: 10.1002/pmrj.12562. Epub 2021 Mar 22. PMID: 33527697