1 in 10 patients develop complications post-coronary artery bypass graft (CABG). Primary care providers improve outcomes by monitoring recovery, optimizing medications and referring if complications occur. Here are 6 key areas to watch for!
1. Wounds: Assess for superficial and deep infections. ‘Mediastinal clicking' is worrying for non-union.
2. Cardiac complications:
New A-fib is common and often transient. Reassess anticoagulation at 3 months.
Post-pericardiotomy syndrome (immune mediated pericarditis) can occur months later, assess with an early echo and treat pericarditis.
Avoid graft occlusion and stenosis with DAPT for 12months post-CABG.
Monitor for CHF exacerbations with regular weights and manage with diuretics.
3. GI Bleeding: Monitor patients on NSAIDS and anticoagulation as intra-operative TEEs can cause trauma and stress ulcers.
4. Diabetes: Tight targets for glycemic control (A1C <7) peri-operatively and post-operatively
5. Blood pressure: antihypertensives are held on cardiopulmonary bypass. Reassess and optimize anti-hypertensive therapy.
6. Mobility: Encourage cardiac rehabilitation and ongoing daily exercise.
Bonus! The Canadian Cardiology Society permits driving 4 weeks post-CABG.
In summary, successful post-CABG care requires primary care providers to closely monitor and manage key areas: wound healing, cardiac complications, GI risks, diabetes, blood pressure, and mobility. Timely intervention and lifestyle modifications are essential to ensure the best possible patient outcomes.
Ref: Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners. https://www.cmaj.ca/content/193/19/E689