Determinants of non-recovery in physical health-related quality of life one year after cardiac surgery: a prospective single Centre observational study

Abstract

Background: Recent studies show that substantial percentage of patients experienced worsening of health related quality of life (HRQoL) 1 year after cardiac surgery. The aim of this study is to identify risk factors that interfere with improvement of HRQoL. Methods: From December 2015 till July 2017 a prospective single centre observational study was carried out in 1920 patients participated who underwent non-salvage cardiac surgery. All patients were requested to complete a Short Form 36 (SF-36) questionnaire before and 1 year after surgery. Primary aim of the study was to identify risk factors for non-recovery in the physical domain of the SF-36 in all cardiac surgery patients. Secondary aim was to identify identical risk factors in patients with isolated coronary artery bypass grafting. Results: After cardiac surgery, the questionnaires for physical and mental health were completed by respectively 803 and 807 patients. Median age was 69[62-75] years, and 77% was male. In comparison to the preoperative status, 176 patients (21.9%) did not display an improvement in the SF-36 physical domain score 1 year after cardiac surgery. In a multivariate analysis independent risk factors for non-recovery in the SF-36 physical domain were baseline SF36 physical domain score (OR 0.954[0.942-0.965], P < 0.001), diabetes (OR 0.437 [0.265-0.720], P 0.001), female sex (OR 0.492 [0.307-0.789], P 0.003), post-operative infection (OR 0.240 [0.109-0.525], P < 0.001) and PCI within 1 year (OR 0.113 [0.036-0.349], P < 0.001) For isolated CABG, 23.2% of patients did not display an improvement in the physical domain score and risk factors appeared to be identical. Conclusions: Twenty two percent of all cardiac surgery patients did not show an improvement in the physical domain score of the HRQoL between the preoperative period and 1 year after surgery. Independent risk factors for non-recovery after cardiac surgery were baseline SF-36 physical domain score, diabetes, female sex, any postoperative infection and the need for PCI in the first year. Further research is needed to tailor the patient selection procedure prior to surgery and potentially modify risk factors in the perioperative process.

Predictors of health-related quality of life after coronary artery bypass graft surgery

“…Symptom experience was identified as a significant factor that affects the PCS score, and this finding is in agreement with the findings of previous studies, which found that symptoms such as depression, anxiety 12 , postoperative adverse effects 9 , angina, and shortness of breath 11 , 19 decreased the PCS score of post-CABG patients. The more serious the post-CABG symptom experience, the more likely it is that the uncertainty and supportive care needs will increase 35 .…”

“…This outscoring of the post-CABG PCS by the post-CABG MCS is attributable to the limitation of everyday physical activity and the decreased treatment compliance rate after CABG 11 , 25 , which can also negatively affect the MCS 7 . One-fifth of CAD patients have a constantly low PCS score after CABG 9 , which highlights the need for a follow-up study to screen the high-risk group with a persistently low PCS score and follow the changing trends of PCS scores from the immediate post-CABG timepoint up to 12 months.…”

“…Recent studies have shown that the HRQOL as well as symptoms, cardiac functions, and performance of daily activities improved in the majority of patients who underwent CABG 5 – 7 . However, in some patients, the HRQOL did not return to baseline levels or even worsened after CABG 8 , 9 . Patients often have post-CABG symptoms such as pain at the incision sites in the chest and leg, respiratory distress, loss of appetite, fatigue, weakness, sleep disturbances, depression, and anxiety 8 , 10 – 13 .…”

Long-term health-related quality of life, healthcare utilisation and back-to-work activities in intensive care unit survivors: Prospective confirmatory study from the Frisian aftercare cohort

“…In addition, a subsequent assessment at three months after discharge has added value in the identification of long-term non-recovery, and can be a trigger for further rehabilitation. This adds to the existing literature, since pre-ICU data on quality of life and physical functioning comes from studies in the elective surgical group [ 14 , 15 ].…”

Effects of neuromuscular electrical stimulation on functional capacity and quality of life among patients after cardiac surgery: A systematic review and meta-analysis

“…The number of people around the world who receive cardiac surgery is increasing [1][2][3][4] . Even a successful cardiac surgery cannot guarantee that patients completely restore physical functions and quality of life (QoL) [5][6][7] . Previous studies have found that even in patients undergoing high-risk elective cardiac surgeries with a good prognosis and a short hospital stay, acute muscle loss occurs due to the imbalance between muscle atrophy and the death of muscle cells [8] .…”