Effect of a Nurse Practitioner–Led Bundled Care on Postoperative Recovery in Cardiac Surgery Patients: A Randomized Controlled Trial

ABSTRACT

Postoperative delirium, pain, and sleep disturbances prolong recovery after cardiac surgery. Evidence for multicomponent, nurse practitioner–led interventions is limited, especially in resource‐constrained settings. This study evaluated their effect on delirium, pain, sleep quality, and hospital stay. In a single‐blinded, post‐test only RCT at a tertiary cardiac hospital in India, 100 adults undergoing elective coronary artery bypass graft, mitral valve replacement, or aortic valve replacement were randomized to nurse practitioner–led bundled care ( n  = 50) or routine care ( n  = 50). The intervention included preoperative orientation, early mobilization, cognitive reorientation, family engagement, relaxation, and sleep promotion. Outcomes‐delirium (CAM‐ICU), pain (VAS), and sleep quality (RCSQ) and length of stay were analyzed using chi‐square/Fisher's exact tests, repeated‐measures ANOVA, GLM, and Mann–Whitney U tests. All 100 participants completed the study ( n  = 50 per group) with comparable baseline demographics and clinical profiles. The intervention group showed significantly lower postoperative delirium (Day 2: 6% vs. 32%, p  = 0.001; GLM group × time interaction p  = 0.009), reduced pain scores across Days 1–3 (F _1,98  = 72.18, p  < 0.001), and improved sleep quality across Days 2–4 (F _1,98  = 233.35, p  < 0.001; group × time interaction p  < 0.001) compared with controls. Recovery was faster, with shorter ICU stay (median 3 vs. 3–4 days, p  = 0.006), ward stay (5 vs. 6 days, p  = 0.002), and total hospital stay (8 vs. 10 days, p  < 0.001). Nurse practitioner–led bundled care reduces delirium, improves pain and sleep, and shortens recovery, providing a feasible, low‐cost approach for cardiac surgery patients.

Trial Registration: CTRI/2023/06/054180 Dated 6/19/2023