Effect of a Nurse Practitioner-Led Bundled Care on Postoperative Recovery in Cardiac Surgery Patients: A Randomized Controlled Trial.
Debajyoti Paul, Puvaneswari Kanagaraj, Padmapriya Pappaiya
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In 30 seconds
This single-blinded, post-test-only randomized controlled trial assessed nurse practitioner-led bundled care in 100 adults undergoing elective coronary artery bypass grafting or valve replacement at a tertiary cardiac hospital in India. Compared with routine care, the intervention was associated with less postoperative delirium, lower pain scores, better sleep quality, and shorter stays. On postoperative Day 2, delirium occurred in 6% of the intervention group versus 32% of controls (p = 0.001); median total hospital stay was 8 versus 10 days (p < 0.001).
Key findings
- Day 2 delirium was 6% with bundled care versus 32% with routine care (p = 0.001); the group × time interaction was p = 0.009.
- Pain scores were lower across Days 1-3 (F 1,98 = 72.18, p < 0.001), and sleep quality improved across Days 2-4 (F 1,98 = 233.35, p < 0.001).
- Median total hospital stay was 8 days with bundled care versus 10 days with routine care (p < 0.001); ward stay was 5 versus 6 days (p = 0.002).
- ICU stay was shorter with bundled care (median 3 vs. 3-4 days, p = 0.006).
Why it matters
Delirium, pain, and sleep disruption can complicate recovery after cardiac surgery. This trial suggests that a coordinated bundle spanning orientation, mobilization, family engagement, relaxation, and sleep promotion may improve several recovery outcomes together. The findings are relevant to evaluating structured perioperative nursing approaches, while the single-hospital setting and trial design warrant caution in generalizing results.
What to keep in mind
The trial was conducted at a single tertiary cardiac hospital in India and used a single-blinded, post-test-only design, which may limit generalizability.