Top

Journal of Cardiothoracic Surgery

Published in:

Open Access 01-12-2021 | CABG | Research article

The effect of postoperative complications on health-related quality of life and survival 12 years after coronary artery bypass grafting – a prospective cohort study

Authors: Matti Hokkanen, Heini Huhtala, Jari Laurikka, Otso Järvinen

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Background

Despite the steady improvements in survival and operative safety, postoperative complications still remain a significant cause of morbidity and mortality after coronary artery bypass grafting (CABG). However, less is known on the impact of postoperative complications on health-related quality of life (QoL). The main objective of our study was to investigate the impact of postoperative complications on long-term QoL and survival after CABG surgery.

Methods

Data of 508 patients, who underwent isolated CABG was prospectively collected. The RAND-36 Health Survey (RAND-36) was used to evaluate patients’ QoL status preoperatively, 1 year and 12 years after the surgery. Predefined postoperative complications were reported during primary and secondary hospital stay. QoL and survival analysis were performed primarily on three patient groups: patients with and without complications and patients with major adverse cardiac and cerebrovascular events (MACCE).

Results

In total 205(40%) of 508 patients had at least one postoperative complication and 73 (14%) experienced MACCE. Patients’ thirty-day, 1-year and 10-year survival rates were, 99, 98, 84% without complications, 97, 95, 72% with complications, and 90, 89, 64% with MACCE, respectively (log-rank p < 0.001). Patients without complications showed significant(p < 0.05) improvements in seven and patients with complications in five out of eight RAND-36 QoL dimensions. All patient groups showed significant improvements in RAND-36 summary scores compared with preoperative values. Patients with complications and especially with MACCE had more profound decline in their RAND-36 summary scores while patients without complications maintained their health status best.

Conclusions

Despite the constant deterioration, both patients with and without complications showed improvements even 12 years after CABG compared with preoperative state. Postoperative complications and especially MACCE were associated with impaired long-term QoL.

D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, et al. The Society of Thoracic Surgeons adult cardiac surgery database: 2019 update on outcomes and quality. Ann Thorac Surg. 2019;107(1):24–32. https://doi.org/10.1016/j.athoracsur.2018.10.004.CrossRefPubMed

Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87–165. https://doi.org/10.1093/eurheartj/ehy394.CrossRefPubMed

Ferguson TB Jr, Hammill BG, Peterson ED, DeLong ER, Grover FL. STS National Database Committee. A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg. 2002;73:480–9.CrossRef

Cornwell LD, Omer S, Rosengart T, Holman WL, Bakaeen FG. Changes over time in risk profiles of patients who undergo coronary artery bypass graft surgery: the veterans affairs surgical quality improvement program (VASQIP). JAMA Surg. 2015;150(4):308–15. https://doi.org/10.1001/jamasurg.2014.1700.CrossRefPubMed

ElBardissi AW, Aranki SF, Sheng S, O’Brien SM, et al. trends in isolated coronary artery bypass grafting: an analysis of the society of thoracic surgeons adult cardiac surgery database. J Thorac Cardiovasc Surg. 2012;143(2):273–81. https://doi.org/10.1016/j.jtcvs.2011.10.029.CrossRefPubMed

Aalto A-M, Aro AR, Teperi J. RAND-36 as a measure of health-related quality of life. reliability, construct validity and reference values in the finnish general population (in Finnish with English Summary). Helsinki: Stakes, Research Reports; 1999. p. 101.

Hays RD, Sherbourne CD, Mazel R. The RAND 36-item health Survey1.0. Health Econ. 1993;2(3):217–77. https://doi.org/10.1002/hec.4730020305.CrossRefPubMed

Ware JE, Sherbourne CD. The MOS-36-item short-form health survey (SF-36). Med Care. 1992;30(6):473–81. https://doi.org/10.1097/00005650-199206000-00002.CrossRef

Hays RD, Stewart AL. The structure of self-reported health in chronic disease patients. Psychological assessment. J Consult Clin Psychol. 1990;58:22–30.CrossRef

10.

Hays RD, Marshall GN, EYI W, Sherbourne CD. Fouryearscross-lagged associations between physical and mental health in the medical outcome study. J Consult Clin Psychol. 1994;62(3):441–9. https://doi.org/10.1037/0022-006X.62.3.441.CrossRefPubMed

11.

Rumsfeld JS, Magid DJ, O’Brien M, McCarthy M Jr, MacWhinney S, Shroyer ALW, et al. Changes in health-related quality of life following cor- onary artery bypass graft surgery. Ann Thorac Surg. 2001;72(6):2026–32. https://doi.org/10.1016/S0003-4975(01)03213-1.CrossRefPubMed

12.

Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367(25):2375–84. https://doi.org/10.1056/NEJMoa1211585.CrossRefPubMed

13.

Serruvs PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med Medicine. 2009;360(10):961–72. https://doi.org/10.1056/NEJMoa0804626.CrossRef

14.

Jawitz OK, Gulack BC, Brennan JM, Thibault DP, Wang A, O’Brien SM, et al. Association of postoperative complications and outcomes following coronary artery bypass grafting. Am Heart J. 2020;222:220–8. https://doi.org/10.1016/j.ahj.2020.02.002.CrossRefPubMedPubMedCentral

15.

Freundlich RE, Maile MD, Hajjar MM, Habib JR, Jewell ES, Schwann T, et al. Years of life lost after complications of coronary artery bypass operations. Ann Thorac Surg. 2017;103(6):1893–9. https://doi.org/10.1016/j.athoracsur.2016.09.048.CrossRefPubMed

16.

Brown PP, Kugelmass AD, Cohen DJ, Reynolds MR, Culler SD, Dee AD, et al. The frequency and cost of complications associated with coronary artery bypass grafting surgery: results from the United States Medicare program. Ann Thorac Surg. 2008;85(6):1980–6. https://doi.org/10.1016/j.athoracsur.2008.01.053.CrossRefPubMed

17.

Gaudino M, Girola F, Piscitelli M, Martinelli L, Anselmi A, Della Vella C, et al. Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay: unmasking an apparent success. J Thorac Cardiovasc Surg. 2007;134(2):465–9. https://doi.org/10.1016/j.jtcvs.2007.04.028.CrossRefPubMed

18.

Lagercrantz E, Lindblom D, Sartipy U. Survival and quality of life in cardiac SurgeryPatients with prolonged intensive care. Ann Thorac Surg. 2010;89(2):490–5. https://doi.org/10.1016/j.athoracsur.2009.09.073.CrossRefPubMed

19.

Diab MS, Bilkhu R, Soppa G, Edsell M, Fletcher N, Heiberg J, et al. The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: a prospective cohort study. J Thorac Cardiovasc Surg. 2018;156(5):1906–15. https://doi.org/10.1016/j.jtcvs.2018.05.076.CrossRefPubMed

20.

Peric V, Borzanovic M, Stolic R, Jovanovic A, Sovtic S, Dimkovic S, et al. Predictors of worsening of patients’ quality of life six months after coronary artery bypass surgery. J Card Surg. 2008;23(6):648–54. https://doi.org/10.1111/j.1540-8191.2008.00667.x.CrossRefPubMed

21.

Herlitz J, Brandrup-Wognsen G, Evander MH, Libungan B, Sjöland H, Caidahl K, et al. Quality of life 15 years after coronary artery bypass grafting. Coron Artery Dis. 2009;20(6):363–9. https://doi.org/10.1097/MCA.0b013e32832c8ced.CrossRefPubMed

22.

Karhunen JP, Jokinen JJ, Raivio PM, Salminen US. Long-term survival and quality of life after cardiac resuscitation following coronary artery bypass grafting. Eur J Cardio-thoracic Surg. 2011;40(1):249–54. https://doi.org/10.1016/j.ejcts.2010.10.042.CrossRef

23.

Williams MR, Wellner RB, Hartnett EA, Thornton B, Kavarana MN, Mahapatra R, et al. Long-term survival and quality of life in cardiac surgical patients with prolonged intensive care unit length of stay. Ann Thorac Surg. 2002;73(5):1472–8. https://doi.org/10.1016/S0003-4975(02)03464-1.CrossRefPubMed

24.

Fox JP, Suter LG, Wang K, Wang Y, Krumholz HM, Ross JS. Hospital-based, acute care use among patients within 30 days of discharge after coronary artery bypass surgery. Ann Thorac Surg. 2013;96(1):96–104. https://doi.org/10.1016/j.athoracsur.2013.03.091.CrossRefPubMedPubMedCentral

25.

Schelling G, Richter M, Roozendaal B, Rothenhäusler HB, Krauseneck T, Stoll C, et al. Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med. 2003;31(7):1971–80. https://doi.org/10.1097/01.CCM.0000069512.10544.40.CrossRefPubMed

26.

Jidéus L, Liss A, Ståhle E. Patients with sternal wound infection after cardiac surgery do not improve their quality of life. Scand Cardiovasc J. 2009;43(3):194–200. https://doi.org/10.1080/14017430802573098.CrossRefPubMed

27.

Salazar JD, Wityk RJ, Grega MA, Borowicz LM, et al. Stroke after cardiac surgery: short-and long-term outcomes. Ann Thorac Surg. 2001;72(4):1195–201.CrossRef

28.

Hunt SM, McKenna SP, Mceven J, Williams J, Papp E. The Nottingham health profile: subjective health status and medical consultations. Soc Sci Med. 1981;15A:221–9.

29.

The EuroQol Group. EuroQoL—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRef

30.

Gao D, Grunwald GK, Rumsfeld JS, Schooley L, MacKenzie T, Shroyer ALW. Time-varying risk factors for long-term mortality after coronary artery bypass graft surgery. Ann Thorac Surg. 2006;81(3):793–9. https://doi.org/10.1016/j.athoracsur.2005.08.005.CrossRefPubMed

Title: The effect of postoperative complications on health-related quality of life and survival 12 years after coronary artery bypass grafting – a prospective cohort study
Authors: Matti Hokkanen
Heini Huhtala
Jari Laurikka
Otso Järvinen
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: CABG
CABG
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01527-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of postoperative complications on health-related quality of life and survival 12 years after coronary artery bypass grafting – a prospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Localization of subcentimeter pulmonary nodules using an indocyanine green near-infrared imaging system during uniportal video-assisted thoracoscopic surgery

Predictive value and regulatory mechanism of serum miR-499a-5p on myocardial dysfunction in sepsis

Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair

Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival

The occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation