Effects of pain, sleep and self-care behavior in patients underwent robotic minimally invasive cardiac surgeries

로봇을 이용한 심장수술이 환자의 통증, 수면 및 자가간호수행에 미치는 영향

  • Received : 2019.04.30
  • Accepted : 2019.07.20
  • Published : 2019.07.28


The purpose of this study was to know the difference in pain, sleep, self-care behavior in patients performed by sternotomy and robotic minimally invasive cardiac surgeries. The participants were 64 patients with sternotomy and 64 patients with minimal thoracotomy in heart valve surgeries at a tertiary hospital in Seoul. Data were analyzed using descriptive statistics, ${\chi}^2$ test, paired t-test. with SPSS/WIN(22.0). The participants with minimally invasive thoracotomy felt severe pain than the patients with thoracotomy at post operation day 2 & 5. The severe pain site were the surgical site in both groups. The participants with sternotomy had better sleep than minimally invasive thoracotomy patients. Self-care behavior was higher in the minimally invasive thoracotomy group. Therefore, despite the many advantages of robotic surgery such as rapid recovery and shortening of length of stay in hospital, accurate pain assessment and application of differentiated protocols are needed for the management of pain in the patients with robotic minimally invasive cardiac surgeries. In addition, a structured education program intervention is needed to improve comfort by considering gender, age, and method of operation.


heart valve surgery;sternotomy;minimally invasive thoracotomy;pain;sleep;self-care behavior

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Fig. 1. Location of pain

Table 1. General & clinical characteristics between median sternotomy group and minimally invasive thoracotomy group

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Table 2. Pain, sleep & self-care behavior between median sternotomy group and minimally invasive thoracotomy group

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Table 3. Pain and Sleep between median sternotomy group and minimally invasive thoracotomy group by the patients’ general & clinical characteristics at POD 2days

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Table 4. Pain and Sleep between median sternotomy group and minimally invasive thoracotomy group by the patients’ general & clinical characteristics at POD 5days

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  1. D. H. Kim & D. H. Kang (2018). Early Surgery in Valvular Heart Disease. Korean circulation journal, 48(11), 964-973. DOI : 10.4070/kcj.2018.0308
  2. The Korean Society for Thoracic & Caridiovascular Surgery. (2010). National Health Information Portal : Guideline oral anticoagulation with prosthetic valve replacement.
  3. S. Cho et al. (2005). Initial experience of robotic cardiac surgery. The Korean Journal of Thoracic and Cardiovascular Surgery, 38(5), 366-370.
  4. E. Beddow, J. Chikwe & B. Glenville. (2006). Cardiothoracic Surgery. Oxford : Oxford University Press.
  5. C. X. Hu, J. Tan, S. Chen, H. Ding & Z. W. Xu. (2014). Comparison of clinical outcomes and postoperative recovery between two open heart surgeries: minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy. Asian Pacific journal of tropical medicine, 7(8), 625-629. DOI : 10.1016/s1995-7645(14)60105-x
  6. M. Seco et al. (2013). Systematic review of robotic minimally invasive mitral valve surgery. Annals of cardiothoracic surgery, 2(6), 704-716. DOI : 10.3978/j.issn.2225-319X.2013.10.18
  7. H. P. Lee et al. (2016). Surgical Outcomes of Cardiac Myxoma: Right Minithoracotomy Approach versus Median Sternotomy Approach. The Korean Journal of Thoracic and Cardiovascular Surgery, 49(5), 356. DOI : 10.5090/kjtcs.2016.49.5.356
  8. L. H. Cohn et al. (1997). Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Annals of surgery, 226(4), 421.
  9. H. G. Je et al. (2008). The first 20 cases of cardiac surgery using the da Vinci (TM) surgical system: a single center experience. The Korean Journal of Thoracic and Cardiovascular Surgery, 41(4), 423-429.
  10. J. D. Schmitto, S. A. Mokashi & Cohn, L. H. (2010). Minimally-invasive valve surgery. Journal of the American College of Cardiology, 56(6), 455-462. DOI : 10.1016/j.jacc.2010.03.05
  11. F. M. Perkins, F & H. Kehlet. (2000). Chronic pain as an outcome of surgery: A review of predictive factors. The Journal of the American Society of Anesthesiologists, 93(4), 1123-1133. DOI : 10.1097/00000542-200010000-00038
  12. N. S. Redeker & C. Hedges. (2002). Sleep during hospitalization and recovery after cardiac surgery. Journal of Cardiovascular Nursing, 17(1), 56-68. DOI : 10.1097/00005082-200210000-00006
  13. N, S. Redeker. j. Roggiero & C. Hedges. (2004). Patterns and predictors of sleep pattern disturbance after cardiac surgery. Research in Nursing & Health, 27(4), 217-224. DOI : 10.1002/nur.20023
  14. W. C. Liao, C. Y. Huang, T. Y. Huang & S. L. Hwang. (2011). A systemic review of sleep patterns and Factors that disturb sleep after heart surgery. Journal of Nursing Research, 19(4), 275-288. DOI : 10.1097/jnr.0b013e318236cf68
  15. X. M. Mulle, F. Tinguely, H. T. Tevaearai, P. Ravussin, F. Stumpe & L. K. von Segesser. (2000). Pain location, distribution, and intensity after cardiac surgery. CHEST, 118(2), 391-396. DOI : 10.1378/chest.118.2.391
  16. X. M. Mulle, F. Tinguely, H. T. Tevaearai, J. P. Revelly, R. Chiolero & L. K. von Segesser. (2000). Impact of duration of chest tube drainage on pain after cardiac surgery. European Journal of Cardio-thoracic Surgery, 18, 570-574. DOI : s1010-7940(00)00515-7
  17. M. J. Lee & K. S. Kim. (2011). Effect of Abdominal Breathing on Postoperative Pain, State Anxiety, Blood Pressure, and Heart Rate of Patients Undergoing Cardiac Surgery, Journal of Korean Critical Care Nursing, 4(1), 37-50.
  18. D. E. Orem, (2001). Nursing: concept of practices 6th Edition. Saint Louis: Mosby Year Book.
  19. P. F. Brennan, S. M. Moore, G. Bjornsdottir, J. Jones, C. Visovsky & M. Rogers. (2001). Heart care an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery. Journal of advanced nursing, 35(5), 699-708. DOI : 10.1046/j.1365-2648.2001.01902.x
  20. R. Allvin, M. Ehnfors, N. Rawal, E. Svensson & E. Idvall. (2009). Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability. Journal of Evaluation in clinical practice, 15(3), 411-419. DOI : 10.1111/j.1365-2753.2008.01027.x
  21. R. M. Suri et al. (2012). Quality of life after early mitral valve repair using conventional and robotic approaches. The Annals of thoracic surgery, 93(3), 761-769. DOI : 10.1016/j.athoracsur.2011.11.062
  22. Y. J. Son. (2001). The relationship between noise and sleep patterns in intensive care units. Journal of Korean Academy of Adult Nursing, 13(2), 209-222.
  23. I. S. Jang & M. H. Choi. (2008). The effect of the environmental nursing intervention on ICU delirium, environmental stress and sleep in patients underwent cardiac surgical procedures. Journal of Korean Clinical Nursing Research, 14(2), 127-138.
  24. T. Jaarsma, K. F. Arestedt, J. Martensson, K. Dracup & A. Stromberg. (2009). The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9): a reliable and valid international instrument. European Journal of Heart Failure, 11(1), 99-105. DOI : 10.1093/eurjhf/hfn007
  25. Y. J. Son, S. H. Kim, S. H. Kim & E. K. Song. (2010). The influences of cognitive function on adherence to self care in elderly patients with heart failure. Korean J. Health Promot, 10, 61-70.
  26. B. Geissler & S. Aggestrup. (2002). Qualitative assessment of pain relief and functional improvement after coronary bypass surgery. A questionnaire survey among 527 patients. Ugeskrift for laeger, 164(11), 1506-1510.
  27. H. Yaliniz et al. (2015). Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects. Asian journal of surgery, 38(4), 199-204. DOI : 10.1016/j.asjsur.2015.01.008
  28. V. Berthoud et al. (2018). Serratus anterior plane block for minimal invasive heart surgery. BMC anesthesiology, 18(1), 144. DOI : 10.1186/s12871-018-0614-5
  29. The Korean pain society. (2018). Textbook of pain medicine 5th edition, Seoul: Koonja
  30. C. Y. Hua, Y. Huang, Y. H. Su, J. Y. Bu & H. M. Tao. (2017). Collaborative care model improves self-care ability, quality of life and cardiac function of patients with chronic heart failure. Brazilian Journal of Medical and Biological Research, 50(11), e6355. DOI : 10.1590/1414-431x20176355
  31. T. Iyigun et al. (2017). Patient body image, self-esteem, and cosmetic results of minimally invasive robotic cardiac surgery. International Journal of Surgery, 39, 88-94. DOI : 10.1016/j.ijsu.2017.01.105
  32. D. Ausili et al. (2016). Clinical and socio-demographic determinants of self-care behaviours in patients with heart failure and diabetes mellitus: a multicentre cross-sectional study. International journal of nursing studies, 63, 18-27. DOI : 10.1016/j.ijnurstu.2016.08.006