Self-rated health is associated with the length of stay at the intensive care unit and hospital following cardiac surgery

BMC Cardiovascular Disorders

Andrea Székely¹  Paul RJ Falger³  Richard J Contrada²  János Gál⁷  Péter Vargha⁵  Piroska Balog⁴  Boglárka Juhász⁶  Attila Tóth¹  Roland Tóth⁶  Eszter Losoncz¹  Zsuzsanna Cserép⁷ 

[1] The Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary;The Department of Psychology, Rutgers the State University of New Jersey, New Brunswick, New Jersey, USA;Department of Psychiatry and Neuropsychiatry, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands;The Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary;The Hungary Heart Center, Semmelweis University, Budapest, Hungary;The Department of Cardiac Surgery of Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary;The Department of Anesthesia and Intensive Care, Semmelweis University, Budapest, Hungary

关键词: Risk stratification;    Cardiac surgery;    Self-rated health;    Happiness;    ICU stay;   

Others  :  1088647
DOI  :  10.1186/1471-2261-14-171

 received in 2014-07-14, accepted in 2014-10-27,  发布年份 2014

【 摘 要 】

Background

Recently, a considerable amount of evidence suggested that anxiety, depression and other psychosocial variables might influence the outcomes of cardiac surgery. This study investigated the relationship between length of stay at the intensive care unit (ICU) and hospital after surgery and different psychosocial variables (e.g. depression, anxiety, self rated health, happiness, satisfaction).

Methods

We enrolled prospective patients who were waiting for elective cardiac surgery (N = 267) and consented to take part in the study. We collected data of sociodemographic, medical and perioperative factors as well as psychosocial questionnaires completed 1.56 days (standard deviation [SD] = 0.7) before surgery. The primary clinical endpoint was an ICU stay of at least 3 days and the secondary was hospital stay of at least 10 days.

Results

Two hundred sixty-seven patients participated in this study. Four patients (1.5%) died in the hospital and 38 patients (14.5%) spent more than 3 days in the ICU and 62 patients (23.2%) spent more than 10 days in the hospital. After controlling for medical and sociodemographic factors, lower self rated health (Adjusted Odds Ratio [AOR]: 0.51, 95% confidence interval [CI]: 0.28-0.95; p = 0.03), lower rate of happiness (AOR: 0.76, 95% CI: 0.59-0.97, p = 0.03), postoperative cardiac failure (AOR: 7.09, 95% CI:1.21-41.54; p = 0.03) and postoperative complications (AOR: 9.52, 95% CI: 3.76-24.11; p < 0.001) were associated with longer ICU stay. More than 10 days of hospital stay was associated with higher occurrence of COPD (AOR 4.56, CI: 1.95-10.67, p < 0.001), NYHA stage (AOR 6.76, CI: 2.57-17.79, p < 0.001), operation time (AOR 1.45, CI: 1.19-1.76, p < 0.001), female gender (AOR 2.16, CI: 1.06-4.40, p = 0.034) and lower self-rated health (AOR 0.63, CI: 0.41-0.99, p = 0.044).

Conclusions

Lower happiness and self-rated health may influence the outcome of cardiac surgery. Therefore, these variables should be assessed in patients.

【 授权许可】

   
2014 Cserép et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L: Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999, 15:816-822.
• [2]Csomós A, Hoffer G, Fülesdi B, Ludwig E: The incidence and cost of severe sepsis in intensive care units. Orv Hetil 2005, 146:1543-1547.
• [3]Cowper PA, Peterson ED, DeLong ER, Jollis JG, Muhlbaier LH, Mark DB: Impact of early discharge after coronary artery bypass graft surgery on rates of hospital re-admission and death. J Am Coll Cardiol 1997, 30:908-913.
• [4]Andrew MJ, Baker RA, Kneebone AC, Knight JL: Mood state as a predictor of neuropsychological deficits following cardiac surgery. J Psychosom Res 2000, 48:537-546.
• [5]Tully PJ, Baker RA, Turnbull D, Winefield H: The role of depression and anxiety symptoms in hospital readmissions after cardiac surgery. J Behav Med 2008, 31:281-290.
• [6]Cserép Z, Balog P, Székely J, Treszl A, Kopp MS, Thayer JF, Székely A: Psychosocial factors and major adverse cardiac and cerebrovascular events after cardiac surgery. Interact Cardiovasc Thorac Surg 2010, 11:567-572.
• [7]STS National Database, data collection STS Adult Cardiac Database v2.52.1. http://www.sts.org/sections/stsnationaldatabase/datamanagers/adultcardiacdb/datacollection/index.html webcite]
• [8]Ferguson TB Jr, Dziubian SW, Edwards FH: Committee to establish a national database in cardiothoracic surgery. The society of thoracic surgeons. The STS database. Current changes and challenges for the new millennium. Ann Thorac Surg 2000, 69:680-691.
• [9]Kopp MS, Skrabski Á, Réthelyi J, Kawachi I, Adler N: Self Rated Health, Subjective Social Status and Middle Aged Mortality in a Changing Society. Behav Med 2004, 30:65-70.
• [10]Perczel Forintos D, Rózsa S, Pilling J, Kopp M: Proposal for a short version of the beck hopelessness scale based on a national representative survey in Hungary. Community Ment Health J 2013, 49(6):822-830.
• [11]Spielberger CD, Gorsuch A, Lushane R, Vagg PR, Jacobs GA: Manual for the State-Trait Anxiety Inventory. Palo Alto, California: Consulting Psychologists Press; 1970.
• [12]Sipos K, Sipos M: The development and validation of the Hungarian form of Spielberger State Trait Anxiety Inventory. In Cross-Cultural Anxiety. Volume 2. Edited by Spielberger CD, Dia-Guerrero R. Washington, New-York, London: Hemisphere Publishing Corporation; 1983:27-39.
• [13]Grös DF, Antony MM, Simms LJ, McCabe RE: Psychometric properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): comparison to the State-Trait Anxiety Inventory (STAI). Psychol Assess 2007, 19(4):369-381.
• [14]Beck AT, Steer RA, Brown GK: Beck Depression Inventory-Second Edition Manual. San Antonio, Texas: The Psychological Corporation; 1996.
• [15]Bowling A: Mode of questionnaire administration can have serious effects on data quality. J Public Health (Oxf) 2005, 27(3):281-291.
• [16]Moore MJ, Moore PB, Shaw P: Mood disturbances in motor neurone disease. J Neurol Sci 1998, 160(Suppl 1):S53-S56.
• [17]Tavakol M, Dennick R: Making sense of Cronbach’s alpha. Int J Med Educ 2011, 2:53-55.
• [18]Johnston G, Goss JR, Malmgren JA, Spertus JA: Health status and social risk correlates of extended length of stay following coronary artery bypass surgery. Ann Thorac Surg 2004, 77:557-562.
• [19]Bucerius J, Gummert JF, Walther T, Doll N, Falk V, Schmitt DV, Mohr FW: Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting. Intensive Care Med 2004, 30:88-95.
• [20]Hannan EL, Racz M, Culliford AT, Lahey SJ, Wechsler A, Jordan D, Gold JP, Higgins RS, Smith CR: Risk Score for Predicting In-Hospital/30-Day Mortality for Patients Undergoing Valve and Valve/Coronary Artery Bypass Graft Surgery. Ann Thorac Surg 2013, 95(4):1282-1290.
• [21]Sabzi F, Moradi GR, Dadkhah H, Poormotaabed A, Dabiri S: Low dose aprotinin increases mortality and morbidity in coronary artery bypass surgery. J Res Med Sci 2012, 17:74-82.
• [22]Hein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C: Prolonged intensive care unit stay in cardiac surgery: Risk factors and long-term-survival. Ann Thorac Surg 2006, 81:880-885.
• [23]Ghotkar SV, Grayson AD, Fabri BM, Dihmis WC, Pullan DM: Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting. J Cardiothorac Surg 2006, 1:14. BioMed Central Full Text
• [24]Messaoudi N, De Cocker J, Stockman B, Bossaert LL, Rodrigus IE: Prediction of prolonged length of stay in the intensive care unit after cardiac surgery: the need for a multi-institutional risk scoring system. J Card Surg 2009, 24:127-133.
• [25]Kjaergaard S, Rees SE, Grønlund J, Nielsen EM, Lambert P, Thorgaard P, Toft E, Andreassen S: Hypoxaemia after cardiac surgery: clinical application of a model of pulmonary gas exchange. Eur J Anaesthesiol 2004, 21:296-301.
• [26]van Hees HW, Li YP, Ottenheijm CA, Jin B, Pigmans CJ, Linkels M, Dekhuijzen PN, Heunks LM: Proteasome inhibition improves diaphragm function in congestive heart failure rats. Am J Physiol Lung Cell Mol Physiol 2008, 294:L1260-L1268.
• [27]Jian L, Sheng S, Min Y, Zhongxiang Y: Risk factors for endotracheal re-intubation following coronary artery bypass grafting. J Cardiothorac Surg 2013, 8:208. BioMed Central Full Text
• [28]Oliveira EK, Turquetto AL, Tauil PL, Junqueira LF Jr, Porto LG: Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting. Rev Bras Cir Cardiovasc 2013, 28(3):353-363.
• [29]Blankstein R, Ward RP, Arnsdorf M, Jones B, Lou YB, Pine M: Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 Midwestern hospitals. Circulation 2005, 112(9 Suppl):I323-I327.
• [30]Koch CG, Khandwala F, Nussmeier N, Blackstone EH: Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison. J Thorac Cardiovasc Surg 2003, 126(6):2032-2043.
• [31]Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS: Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 1998, 66(1):125-131.
• [32]Schroeder S, Baumbach A, Herdeg C, Oberhoff M, Buchholz O, Kuettner A, Hanke H, Karsch KR: Self-rated health and clinical status after PTCA: results of a 4-year follow-up in 500 patients. Eur J Intern Med 2001, 12:101-106.
• [33]Norekvål TM, Fridlund B, Rokne B, Segadal L, Wentzel-Larsen T, Nordrehaug JE: Patient-reported outcomes as predictors of 10-year survival in women after acute myocardial infarction. Health Qual Life Outcomes 2010, 8:140. BioMed Central Full Text
• [34]Oxlad M, Wade TD: Longitudinal risk factors for adverse psychological functioning six months after coronary artery bypass graft surgery. J Health Psychol 2008, 13:79-92.
• [35]Jylhä M: What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 2009, 69:307-316.
• [36]Arnadottir SA, Gunnarsdottir ED, Stenlund H, Lundin-Olsson L: Determinants of self-rated health in old age: a population-based, cross-sectional study using the International Classification of Functioning. BMC Public Health 2011, 11:670. BioMed Central Full Text
• [37]Bambauer KZ, Aupont O, Stone PH, Locke SE, Mullan MG, Colagiovanni J, McLaughlin TJ: The effect of a telephone counseling intervention on self-rated health of cardiac patients. Psychosom Med 2005, 67(4):539-545.
• [38]Rozanski A, Blumenthal JA, Kaplan J: Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999, 99:2192-2217.
• [39]Steptoe A, Wardle J, Marmot M: Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes. Proc Natl Acad Sci U S A 2005, 102:6508-6512.
• [40]Steptoe A, Dockray S, Wardle J: Positive affect and psychobiological processes relevant to health. J Pers 2009, 77:1747-1776.
• [41]Scheier MF, Matthews KA, Owens JF, Schulz R, Bridges MW, Magovern GJ, Carver CS: Optimism and rehospitalization after coronary artery bypass graft surgery. Arch Intern Med 1999, 159:829-835.
• [42]Kawachi I, Sparrow D, Vokonas PS, Weiss ST: Symptoms of anxiety and risk of coronary heart disease. Normative Aging Study Circulation 1994, 90:2225-2229.
• [43]Rosenbloom JI, Wellenius GA, Mukamal KJ, Mittleman MA: Self-reported anxiety and the risk of clinical events and atherosclerotic progression among patients with Coronary Artery Bypass Grafts (CABG). Am Heart J 2009, 158:867-873.
• [44]Krantz D, Helmers K, Bairey CN, Nebel L, Hedges S, Rozanski A: Cardiovascular reactivity and mental stress-induced myocardial ischemia in patients with coronary artery disease. Psychosom Med 1991, 53:1-12.
• [45]Pirraglia PA, Peterson JC, Williams-Russo P, Gorkin L, Charlson ME: Depressive symptomatology in coronary artery bypass graft surgery patients. Int J Geriatr Psychiatry 1999, 14:668-680.
• [46]Contrada RJ, Goyal TM, Cather C, Rafalson L, Idler EL, Krause TJ: Psychosocial factors in outcomes of heart surgery: The impact of religious involvement and depressive symptoms. Health Psychol 2004, 23:227-238.
• [47]Oxlad M, Stubberfield J, Stuklis R, Edwards J, Wade TD: Psychological risk factors for increased post-operative length of hospital stay following coronary artery bypass graft surgery. J Behav Med 2006, 29:179-190.
• [48]Horne D, Kehler S, Kaoukis G, Hiebert B, Garcia E, Duhamel TA, Arora RC: Depression before and after cardiac surgery: do all patients respond the same? J Thorac Cardiovasc Surg 2013, 145:1400-1406.
• [49]Poole L, Leigh E, Kidd T, Ronaldson A, Jahangiri M, Steptoe A: The combined association of depression and socioeconomic status with length of post-operative hospital stay following coronary artery bypass graft surgery: data from a prospective cohort study. J Psychosom Res 2014, 76:34-40.
• [50]Majed B, Arveiler D, Bingham A, Ferrieres J, Ruidavets JB, Montaye M, Appleton K, Haas B, Kee F, Amouyel P, Ducimetiere P, Empana JP, PRIME Study Group: Depressive symptoms, a time-dependent risk factor for coronary heart disease and stroke in middle-aged men: the PRIME Study. Stroke 2012, 43(7):1761-1767.
• [51]Jenkins CD, Jono RT, Stanton BA: Predicting completeness of symptom relief after major heart surgery. Behav Med 1996, 22:45-57.
• [52]Goldman N, Glei DA, Chang MC, Glei DA, Chang MC: The role of clinical risk factors in understanding self-rated health. Ann Epidemiol 2004, 14(1):49-57.