Health-related quality of life after cardiac surgery – the effects of age, preoperative conditions and postoperative complications

Journal of Cardiothoracic Surgery

Věra Adámková¹  Ladislav Pešl²  Alan Bulava⁴  Júlia Čanádyová⁵  Martina Krupauerová³  Aleš Mokráček⁵  Vojtěch Kurfirst⁵ 

[1] Preventive Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic;Department of Cardiology, Hospital České Budějovice, České Budějovice, Czech Republic;KardioECHO Cardiology Outpatients Department, České Budějovice, Czech Republic;Faculty of Health and Social Studies, University of South Bohemia, České Budějovice, Czech Republic;Cardiac Surgery Department, Boženy Němcové str. 54, Hospital České Budějovice, České Budějovice, Czech Republic

关键词: Cardiac surgery;    Older patients;    Postoperative complications;    Health-related quality of life;   

Others  :  811334
DOI  :  10.1186/1749-8090-9-46

 received in 2013-09-12, accepted in 2014-02-04,  发布年份 2014

【 摘 要 】

Background

Factors influencing the postoperative health-related quality of life (HRQOL) after cardiac surgery have not been well described yet, mainly in the older people. The study’s aim was to explore differences in clinical conditions and HRQOL of patients before and after cardiac surgery taking into account the influence of age and to describe factors influencing changes of HRQOL in the postoperative period.

Methods

This was a prospective consecutive observational study with two measurements using the SF-36 questionnaire before surgery and 1 year after surgery. It considered main clinical characteristics of participants prior to surgery as well as postoperative complications.

Results

At baseline assessment the study considered 310 patients, predominantly male (69%). Mean age was 65 (SD 10.4) years and 101 patients (33%), who were older than 70, constituted the older group. This older group showed greater comorbidity, higher cardiac operative risk and lower HRQOL in the preoperative period as well as a higher prevalence of postoperative complications than the younger group. Thirty-day mortality was 1.4% in the younger group and 6.9% in the older group (p < 0.001). One year mortality was 3.3% in the younger group and 10.9% in the older group (p < 0.001). There was a significant improvement in all 8 health domains of the SF-36 questionnaire (p < 0.001) in the overall sample. There was no significant difference in change in a majority of HRQOL domains between the younger and the older group (p > 0.05). Logistic multivariate analysis identified a higher values of preoperative PCS (Physical component summary) scores (OR 1.03, CI 1.00 – 1.05, p = 0.0187) and MCS (Mental component summary) scores (OR 1.02, CI 0.997 – 1.00, p = 0.0846) as the only risk factors for potential non-improvement of HRQOL after cardiac surgery after correction for age, gender and type of surgery.

Conclusions

Older patients with higher operative risk have lower preoperative HRQOL but show a similar improvement in a majority of HRQOL domains after cardiac surgery as compared with younger patients. The multivariate analysis has shown the higher preoperative HRQOL status as a only significant factor of potential non-improvement of postoperative HRQOL.

【 授权许可】

   
2014 Kurfirst et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Noyez L, de Jager MJ, Markou ALP: Quality of life after cardiac surgery: underresearch research. Interactiv Cardiovasc Thorac Surg 2011, 5:511-515.
• [2]Huber CH, Goeber V, Berdat P, Carrel T, Eckstein F: Benefits of cardiac surgery in octogenarians – a postoperative quality of life assessment. Eur J Cardiothorac Surg 2007, 31:1099-1105.
• [3]Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G: Accuracy, calibration and clinical performance of the EuroSCORE: can we reduce the number of variables? Eur J Cardiothorac Surg 2010, 37:724-729.
• [4]Kolh P, Kerzmann A, Lahaye L, Gerard P, Limet R: Cardiac surgery in octogenarians: perioperative outcome and long-term results. Eur Heart J 2001, 22:1235-1243.
• [5]Naunheim KS, Dean PA, Fiore AC, McBride LR, Pennington DG, Kaiser GC, Barner HB: Cardiac surgery in the octogenarian. Eur J Cardiothorac Surg 1990, 3:130-135.
• [6]Frélich M, Štětka F, Pokorný P, Útrata P, Bedáňová H, Ondrášek J, Pavlík P, Wagner R, Černý J: Cardiac surgery in elderly patients. Scripta Medica 2003, 6:341-346.
• [7]Chocron S, Rude N, Dussaucy A: Quality of life after open-heart surgery in patients over 75 years old. Age Ageing 1995, 25:8-11.
• [8]Shan L, Saxena A, McMahon R, Wilson A, Newcomb A: A systematic review on the quality of life benefits after aortic valve replacement in the elderly. J Thorac Cardiovasc Surg 2013, 5:1173-1189.
• [9]Engoren M, Arslanian-Engoren C, Steckel D, Neihardt J, Fenn-Buderer N: Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery. Chest 2002, 4:1309-1315.
• [10]Beghé C, Wilson A, Ershler WB: Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med 2004, 7:3-10.
• [11]Ko W, Krieger KH, Lazenby WD, Shin YT, Goldstein M, Lazzaro R, Isom OW: Isolated coronary artery bypass in one hundred consecutive octogenarian patients. J Thorac Cardiovas Sur 1991, 102:532-538.
• [12]Petr P, Vurm V, Soukupova A: Czech version of the SF – 36 questionnaire. Kontakt 2002, 1(Suppl):10-15.
• [13]Marquis P, Fayol C, Joire JE: Clinical validation of a quality of life questionnaire in angina pectoris patiens. Eur Heart J 1995, 11:1554-1560.
• [14]Zuluaga MC, Guallar-Castilón P, Lopéz-García E, Banegas JR, Conde-Herrera M, Olcoz-Chiva M, Rodriguez-Pascual C, Rodriguez-Artaleho F: Generic and disease-specific quality of life as a predictor of long-term mortality in heart failure. Eur J Heart Fail 2010, 12:1372-1378.
• [15]van den Berg MP, Hassink RJ, Tuinenburg AE, van Sonderen EFLP, Lefrandt JD, de Kam PJ, van Gelder IC, Smit AJ, Sanderman R, Crijns HJGM: Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J 2001, 3:247-253.
• [16]Jensen BÖ, Hughes P, Rassmusen LS, Pendersen PU, Steinbruchel DA: Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients: a randomized trial. Eur J Cardiothorac Surg 2006, 8:294-299.
• [17]Goldsmith IRA, Gregory YHL, Ramesh LP: A prospective study of changes in the quality of life of patients following mitral valve repair and replacement. Eur J Cardiothorac Surg 2001, 11:949-955.
• [18]Hansen L, Winkel S, Kuhr J, Bader R, Bleese N, Riess FC: Factors influencing survival and postoperative quality of life after mitral valve reconstruction. Eur J Cardiothorac Surg 2010, 3:635-644.
• [19]Santini F, Montalbano G, Messina A, D'Onofrio A, Casali G, Viscardi F, Luciani GB, Mazzucco A: Survival and quality of life after repair of acute type A aortic dissection in patients aged 75 years and older justify intervention. Eur J Cardiothorac Surg 2006, 3:386-391.
• [20]Lönnerholm S, Blomström P, Nilsson L, Blomström-Lundqvist C: A high quality of life is maintained late after Maze III surgery for atrial fibrillation. Eur J Cardiothorac Surg 2009, 9:558-562.
• [21]Koertke H, Hoffmann-Koch A, Boethig D, Minami K, Breymann T, El-Arousy M, Seifert D, Koerfer R: Does the noise of mechanical heart valve prostheses affect quality of life as measured by the SF-36® questionnaire? Eur J Cardiothorac Surg 2003, 7:52-58.
• [22]Ware JE: SF-36 health survey update. Spine 2000, 24:3130-3139.
• [23]Ware JE, Kosinsky M: Interpreting SF-36 summary health measures: a response. Qual Life Res 2001, 5:405-413.
• [24]Statistica 10 software Czech version. Web: http://www.statsoft.com webcite
• [25]XLSTAT version 2011 software. Web: http://www.xlstat.com webcite
• [26]Rumsfeld JS, Magid DJ, O´Brien M: Changes in health related quality of life following coronary artery bypass graft surgery. Ann Thorac Surg 2001, 72:2026-2032.
• [27]Glower D, Christopher T, Milano C, White WD, Smith LR, Jones RH, Sabiston DC: Performance status and outcome after coronary artery bypass grafting in persons aged 80 to 93 years. Am J Cardiol 1992, 6:567-571.
• [28]Mullany CH, Darling GE, Pluth JR, Orszulak TA, Schaff HV, Iistrup DM, Gersh BJ: Early and late results after isolated coronary artery bypass surgery in 159 patients aged 80 years and older. Circulation 1990, 82(Suppl IV):229-236.
• [29]Khan JH, McElhinney DB, Hall TS, Merrick SH: Cardiac valve surgery in octogenarians. Arch Surg 1998, 8:887-893.
• [30]Le Grand MR, Elliot PC, Murphy BM, Worcester MUC, Higgins RO, Ernest CS, Goble AJ: Health related quality of life trajectories and predictors following coronary artery bypass surgery. Health Qual Life Outcomes 2006, 4:1-13. BioMed Central Full Text
• [31]Dumbor LN, Britchford G, Cale ARJ: The influence of an ageing population on care and clinical resource utilisation in cardiac surgery. Br J Cardiol 2011, 6:28-32.
• [32]Lee J, Govindan S, Celi LA, Khabbaz KR, Subramaniam B: Cusomized prediction of short length of stay following elective cardiac surgery in elderly patients using a genetic algorithm. World J Cardiovasc Surg 2013, 3:163-170.
• [33]Grady KL, Lee R, Subacius H, Malaisrie SC, McGee EC, Kruse J, Goldberger JJ, McCarthy PM: Improvements in healt-related quality of life before and after isolated cardiac operations. Ann Thorac Surg 2011, 91:777-783.
• [34]Gjeilo KH, Wahba A, Klepstad P, Lydersen S, Stenseth R: Health-related quality of life three years after coronary surgery: a comparison with the general population. Scand Cardiovasc J 2006, 1:29-36.