Comparison of post-operative pain, stress response, and quality of life in port access vs. standard sternotomy coronary bypass patients.
OBJECTIVE
Although it has been postulated that minimally invasive cardiac surgery using the port access method would reduce operative stress and postoperative pain and accelerate postoperative recovery to a good quality of life, few data are currently available to document this intuitively appealing claim. Therefore, this study was designed to examine differences in stress response, postoperative pain, rapidity of recovery, and quality of life after port access (PA) isolated coronary artery bypass surgery compared with standard sternotomy (STD) isolated coronary bypass surgery.


METHODS
Fourteen PA and 15 STD coronary bypass patients were studied postoperatively for pain score, FEV, catecholamine and cortisol levels, resumption of activity, and Duke Activity Scale ratings. The surgical approach was based on the surgeon's preference. Although the PA patients were younger, there were no other differences between the groups in gender or preoperative risk factors.


RESULTS
There were no operative deaths and no differences between the groups in perioperative complications. Repeated measures analysis of variance showed lower pain scale ratings over the first 4 postoperative weeks in the PA group (P < 0.001). The PA patients also had less muscle soreness, shortness of breath, fatigue, and poor appetite at 1, 2, 4, and 8 weeks (P < 0.05), better FEV at 1 day (1.59 vs. 0.97 l/s; P < 0.02) and 3 days (2.20 vs. 1.49 l/s; P < 0.03), and lower norepinephrine levels at days 1, 2, and 3 (P = 0.005). The Duke Activity Scale questionnaire results demonstrated that more PA patients were able to walk 1-2 blocks at 1 week, climb stairs at 1 and 2 weeks, perform light or moderate housework at 1 and 2 weeks, and engage in moderate recreational activities and perform heavy housework at 4 and 8 weeks (P < 0.05).


CONCLUSIONS
These results show that compared with STD coronary bypass patients PA patients enjoyed significant postoperative physiologic and quality of life advantages with less pain, less early stress response, better pulmonary function, and superior Duke Activity scores during the first 2 postoperative months.
Grossi
E A
EA
Department of Surgery, New York University School of Medicine, NY, USA. grossi@cv.med.nyu.edu
Zakow
P K
PK
Ribakove
G
G
Kallenbach
K
K
Ursomanno
P
P
Gradek
C E
CE
Baumann
F G
FG
Colvin
S B
SB
Galloway
A C
AC
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002395:Catecholamines / Q000097:blood; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000503:physiopathology; D011788:Quality of Life; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013312:Stress, Physiological / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D014667:Vasopressins / Q000097:blood
D015415:Biomarkers; D002395:Catecholamines; D014667:Vasopressins; D006854:Hydrocortisone