O2047: Physical Therapy Assessment in Post-congenital Heart Surgery Clinic Identifies Needs Not Appreciated at Time of Discharge

Background: Promotion of mobility after adult acquired cardiac surgery with programs like cardiac rehabilitation improves quality of life, reduces mortality, and is the standard of care. Limited studies have examined physical dysfunction following surgery in children and adults with congenital heart disease. Inconsistent referral practices and lack of standardized rehabilitative care for this population may lead to persistent dysfunction. This study aims to evaluate the rehabilitation needs of patients in the postoperative clinic following congenital heart surgery.

Methods: Retrospective review of all congenital heart postoperative clinic patients between 1/21/2022-10/14/2022. Patients following sternotomy were evaluated by a physical therapist(PT). Evaluations included skilled assessment of posture, upper extremity range of motion, pain and gross motor skills, as well as patients’ understanding of sternal precautions. Patient demographics, clinical data, and PT reports were reviewed. Descriptive and univariate statistics were utilized.

Results: A total of 111 patients were identified: 36(32%) infants, 19(17%) toddlers, 23(21%) school aged children, 33(30%) teens and adults(TA).(Table 1) Thirty-one(28%) patients had a non-cardiac congenital abnormality and 50(45%) were diagnosed with a syndrome. Patients were seen in clinic a median of 10[IQR: 9-13] days following surgery. Twelve(11%) demonstrated no additional PT needs and there were significant differences in proportions among age groups (p < 0.001). Clarification of sternal precautions were needed in 35(32%), with caregivers of infants requiring the majority of education.(Table 2) .Overall, 74(67%) were recommended for additional outpatient rehabilitation, with TA having a higher proportion of impaired posture, difficulty sleeping, and persistent pain. PT provided home exercise programs for 53(48%). At the time of hospital discharge 20(18%) were given PT referrals. All (20/20) continued to exhibit PT needs at the postoperative clinic. Additionally 54(59%) of the 91 who did not receive a referral at discharge were identified as needing outpatient PT intervention. PT assessment led to the recognition of previously undiagnosed developmental delay in 4/19(21%) toddlers.

Conclusion: Significant PT needs were identified in a congenital heart postoperative clinic, including needs not identified while inpatient. Providing in-depth patient and caregiver education is challenging in the cardiac ICU, and physical dysfunction is sometimes difficult to assess and can be masked in the acute postoperative setting, likely due to circumstances and stressors of the environment. The clinic setting is conducive to PT assessments, by providing patients and families with a non-stressful and engaging environment, allowing for more in depth education. Integration of PT in congenital heart surgery postoperative clinic will facilitate identification of needs as well as timely referrals and treatment plans to expedite recovery following surgery.