Reflecting on my experience after coronary artery bypass grafting.

I am prompted to respond to the CMAJ article “Management of Patients After Coronary Artery Bypass Grafting Surgery: A Guide for Primary Care Practitioners.”1

I compared my own experience 14 months ago, when I had double bypass surgery, with the typical outcomes detailed in the article.

I was not readmitted within 30 days, as occurs in patients older than 80 years (I was 81).

I did not develop cardiac tamponade, which occurs in 1%–12.6% of patients.

I did not have a perioperative myocardial infarction, which occurs in 0.6%–19% of patients.

I have not had a graft occlusion, which occurs in 2%–5% of patients per annum.

I did not develop pneumonia, which occurs in 2.4% of patients.

I did not have any cognitive dysfunction, which affects 50%–70% of patients. I did not develop depression, euphoria or anxiety.

I did not have postoperative delirium, which affects 73% of patients.

I did not develop kidney dysfunction, which affects 30% of patients.

I did not develop atrial fibrillation, which affects 30% of patients.

Not seeing a general practitioner (GP) within 30 days is associated with 5 times worse outcomes. I did not get to see my GP within 30 days because of the COVID-19 pandemic, and have not seen her yet, although I have had the best possible care by telephone.

It therefore appears that my outcome was remarkably good, for which I am very thankful. Two factors may have helped: for an electrophysiology study, I was kept in hospital an extra 4 days; then, for 5 days, I had phone access to a skilled nurse practitioner.

This leads me to 2 reflections.

I am happy I was not aware of the possible outcomes described in the article, as I would have been full of trepidation.

I actually had complications not mentioned by the authors in their literature review, which focused on dire outcomes. These were as follows:

Pain on coughing or sneezing which, I was informed, might have been a result of minor cracks in my ribs.

Dehiscence of a leg wound — the site of harvest of my left saphenous vein graft, which took 4 months to heal.

Electric shock feelings in the lower left leg, which went on for 9 months and were attributed to nerves being cut during the saphenous harvesting.

Swelling of the lower left leg, which I am told is permanent, although now minimal.

Feelings of light-headedness when walking; it was discovered I had developed iron-deficiency anemia.

Thus, I have 4 suggestions:

Coronary artery bypass grafting has a very complex recovery period and the GP should have ongoing, rapid access to the cardiologist and surgeon.

Although surgeons have a legal responsibility to inform patients of potential risks, carrying out that responsibility in detail may have negative impact and should be done cautiously.

Postoperative hospital stays should be at least a week.

During the first week after discharge, there should be daily follow-up by phone with the cardiology team.