Effect of clinical pathway implementation and patients' characteristics on outcomes of coronary artery bypass graft surgery

Abstract

Recently, the use of Clinical Pathways (CP) as a method of delivering care was initiated and introduced at the University Medical Center Groningen (UMCG) in the Netherlands, and was used as a method of care for patients undergoing cardiac surgery since 2004 at the thoracic surgery department. The aim of this study was to determine the difference between CP and conventional care in terms of health related functional status (HRFS), depression, and anxiety, as well as to determine the relative contribution of CP towards an improved HRFS after coronary artery bypass graft surgery (CABG). We found that implementing a clinical pathway did not decrease the length of stay (LOS), and there was no difference between patients in relation to complications. We also found that patients in the conventional care plan improved more than patients in the CP concerning HRFS. In this study we also depicted that EuroSCORE was associated with physical functioning before and after surgery and with LOS and number of complications. Moreover, EuroSCORE was found to be a predictor of physical HRFS. In addition, we presented in this study the predictors of deterioration in HRFS after CBAG and the role played by Type D personality along with the mediating effect of change in anxiety and depression, leading to deterioration in HRFS. We established that history of angina, increased anxiety and depression were predictors of deterioration in HRFS, and by structural equation modeling we found that increased anxiety and depression mediated the relationship between Type D and deterioration mental and physical HRFS after CABG.