Cork University Hospital support pre-op work-up for heart patients to avoid ‘PJ paralysis’

Patients prepping for major heart surgery at Cork University Hospital are to be involved in a pre-operative “work-up”.

The focus will be on physically and psychologically preparing patients before they are admitted.

The hospital’s chief executive Tony McNamara said it supported initiatives such as ‘end PJ paralysis’ to get patients mobile with a mindset that is focused on activity rather than passivity.

The hospital’s cardio-thoracic service that opened in 2010 currently employs three consultant surgeons and their teams.

Mr McNamara said it was likely that at least two more surgeons and their teams would be employed over the next three years.

He said waiting lists were relatively small because they were managed on a weekly basis with the cardio- thoracic surgeons and their teams.

Mr McNamara said challenges in introducing a minimally invasive cardiac surgery had been successfully overcome.

The team had completed almost 70 minimally invasive cardiac surgery procedures to date with excellent outcomes and expected to reach 100 such procedures by early next year.

There was less blood loss in the procedure and recovery time was shorter.

They had also adopted the video-assisted thoracic surgery technique for the extraction of part of the lung.

The results to date are excellent and patients are now, quite rightly, demanding this procedure over traditional means of performing resections,” said Mr McNamara.

He pointed out that 84% of cancer lesions detected in lung cancer screening programmes are suitable for excision using video-assisted thoracic surgery.

During cardiac surgery, there was an increased focus on pain-management, active warming of the blood, and the avoidance of prophylactic nasal gastric tubes and drains, making post-surgery management easier for the patient.

In the post-surgery phase, there was a particular focus on early ambulation, early oral nutrition, early removal of catheters and psychologically preparing the patient for discharge.

Each of these interventions reflects emerging best practice in patient care with a focus on minimising trauma for patients and facilitating their early discharge from hospital.

The cardio thoracic service in Cork University Hospital is one of four adult cardiac services in Ireland and covers a catchment area of one million people in Munster.

Last year, the service carried out 278 coronary artery bypass procedures to restore normal blood flow to an obstructed coronary artery.

There were 100 valve-only procedure and 31 combined coronary artery bypass and valve procedures.

There were 75 “other cardiac” operations carried out, 64 thoracotomies (a chest incision) to access organs and 173 video-assisted thoracic surgical procedures.

Other key changes include the implementation of protected theatre time for primary lung resections.

This has resulted in substantial improvements in the number of such procedures carried out this year. Such procedures currently range between four and eight a week.