The purpose of this study is to investigate the factors associated with upper and lower limb muscle weakness after cardiac surgery.
This study included patients who underwent cardiac surgery at our hospital. Patients requiring assistance with activities of daily living preoperatively, and those who had difficulty walking postoperatively, were excluded. Grip strength, five-time sit-to-stand speed, and isometric knee extension strength were evaluated preoperatively and on the day before discharge. Additionally, clinical laboratory test results, treatments, and rehabilitation before, during, and after surgery were collected from medical records. A two-group comparison was conducted between patients with and without muscle weakness for these factors. Logistic regression analysis was performed with muscle weakness as the dependent variable, using factors that showed significant associations in the two-group comparison as independent variables.
A total of 128 patients (72.7±11.1 years old, 71 males) were analyzed. Grip strength decreased in 93 patients (72.7%), sit-to-stand speed decreased in 66 patients (52.0%), and knee extension strength decreased in 77 patients (68.1%). Patients with reduced grip strength had a lower incidence of diabetes and dyslipidemia, higher preoperative %vital capacity, less pain at discharge, and fewer instances of low motivation for rehabilitation (p0.05). Patients with decreased sit-to-stand speed had a lower preoperative left ventricular ejection fraction, more preoperative anxiety, longer surgery duration, more days of postoperative oxygen therapy, and a longer time to initiate gait training (p0.05). Patients with reduced knee extension strength were less likely to have a history of alcohol consumption, had a lower preoperative forced expiratory volume in one second (FEV1%), required more days of postoperative oxygen therapy, and took longer to start walking practice (p0.05). Logistic regression analysis showed no significant factors related to grip strength decline. However, slower sit-to-stand speed was significantly associated with longer surgery duration (p=0.01), and decreased knee extension strength was significantly associated with lower preoperative FEV1% and delayed initiation of gait training (p0.05).
This study suggests that lower preoperative respiratory function and longer surgery duration negatively impact postoperative lower limb muscle strength. Additionally, a delayed start of gait training postoperatively was associated with decreased lower limb muscle strength. In contrast, factors related to upper limb muscle weakness require further investigation.
Efforts to improve respiratory function before cardiac surgery and special postoperative measures to prevent muscle weakness after surgery should be considered for patients with factors related to muscle weakness. Furthermore, multidisciplinary collaboration to start gait training early may be important.
muscle weakness
related factors
