Effects of a Recovery-Promoting Program in Patients Undergoing CABG Surgery

Coronary artery bypass graft (CABG) surgery is a standard treatment for patients with advanced coronary artery disease. Although surgical outcomes have improved, patients frequently experience challenges during postoperative recovery, including reduced physical capacity, delayed functional recovery, psychological distress, and difficulties in self-management after hospital discharge. These challenges may contribute to prolonged recovery and suboptimal clinical outcomes.

Evidence-based approaches such as Cardiac Rehabilitation (CR) and Enhanced Recovery After Cardiac Surgery (ERAS) have been shown to support postoperative recovery. However, in routine clinical practice, the application of these approaches is often fragmented, and continuity of care after discharge remains limited. In particular, patients may receive insufficient guidance and support to enhance self-efficacy and confidence in managing recovery at home.

This study aims to evaluate the effects of a recovery-promoting program on self-efficacy, quality of recovery, and clinical outcomes in patients undergoing CABG surgery. The recovery-promoting program integrates key components of CR and ERAS principles and is delivered by nurses using a structured approach. The intervention includes pre-discharge education, guidance on postoperative activity and symptom management, and follow-up support after discharge through a tele-nursing platform. This approach is designed to enhance patients' engagement in recovery and support continuity of care beyond hospital discharge.

A quasi-experimental design is used to compare outcomes between patients receiving standard postoperative care and those receiving the recovery-promoting program in addition to standard care. Eligible patients are assigned to either a control group or an experimental group according to the study protocol. Data are collected at predefined time points to evaluate changes in self-efficacy, quality of recovery, and selected clinical outcomes.

Self-efficacy and quality of recovery are assessed using validated instruments, while clinical outcomes are obtained from clinical records and routine assessments. The primary focus of the study is to examine differences between groups over time and to explore the potential role of a structured, nurse-led recovery-promoting program in supporting postoperative recovery following CABG surgery.

The findings of this study are expected to contribute to evidence supporting integrated recovery strategies and tele-nursing approaches in postoperative cardiac care and may inform the development of structured nursing interventions to improve recovery outcomes in patients undergoing CABG surgery.

Inclusion criteria

• Thai patients undergoing elective first-time on-pump coronary artery bypass graft (CABG) surgery alone or combined with valve surgery
• If age >60 years, participants must pass cognitive screening using the 6-Item Cognitive Impairment Test (6-CIT)
• New York Heart Association (NYHA) functional class I-III
• Left ventricular ejection fraction (LVEF) >30%
• Independent in activities of daily living and able to perform the 6-minute walk test (6MWT)

Exclusion criteria

• Severe or acute comorbidities within 24 hours prior to surgery (e.g., chronic obstructive pulmonary disease, renal failure, acute myocardial infarction, severe arrhythmia)
• Severe postoperative complications or unstable vital signs (e.g., major bleeding, significant arrhythmia, embolism, need for dialysis, extracorporeal membrane oxygenation)
• Disability or limited ambulation or mobility assessed prior to hospital discharge
• Failure of extubation within 3 days after surgery or requirement for reoperation