Coronary Artery Bypass Grafting: Patients' and Health Professionals' Views of Recovery After Hospital Discharge

Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery

Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the "second victim," results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.

Examining symptom trajectories that predict worse outcomes in post-CABG patients

BACKGROUND

Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians' abilities to support symptom recovery.

AIMS

To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively.

METHODS

A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and at 1 week, 6 weeks and 3 months following coronary artery bypass grafting. A latent class growth model and multivariate logistic regression analyses were used.

RESULTS

Data were obtained from patients ( N=198) undergoing coronary artery bypass grafting in six medical centres of Taiwan, through patient medical records and interviews. Based on their frequency, trajectories were explored for the six most common postoperative symptoms including angina, dyspnoea, fatigue, depression, sleep problems and anxiety. We identified two to three distinct classes of trajectories for each symptom. Age, longer intensive care unit stay, fewer vessels bypassed, off-pump coronary artery bypass grafting, smoking history and lack of regular exercise were associated with worse symptom outcome trends over time.

CONCLUSIONS

Using this unique trajectories-based research method, we are able to achieve a better understanding of symptom recovery patterns over time among coronary artery bypass grafting patients. Recognising risk factors and potential recovery patterns prior to surgery may allow healthcare providers to deliver targeted discharge planning and individualised care after coronary artery bypass grafting.

Impact of post-hospital cardiac rehabilitation on the quality of life of patients after surgical treatment for coronary artery disease

INTRODUCTION

The quality of life of cardiovascular patients is worse than that of healthy individuals. Pain, dyspnea, and fatigue impair daily activities, which in turn leads to decreased life satisfaction and emotional deterioration. The objective of comprehensive treatment, including early rehabilitation, is to reduce the risk of complications, progression, and recurrence of the disease, as well as to restore, maintain, or improve all aspects of the patient's quality of life to the greatest extent possible.

AIM

To assess the quality of life of patients who underwent surgical treatment for coronary artery disease and completed the second phase of cardiac rehabilitation.

MATERIAL AND METHODS

The study enrolled 100 patients undergoing early cardiac rehabilitation in stationary conditions after coronary artery bypass grafting. The group included 21 women and 79 men; their age ranged from 40 to 75 years. The study employed a questionnaire of our own design.

RESULTS

Post-hospital cardiac rehabilitation resulted in quality of life improvements, especially with regard to psychological aspects, reducing the occurrence of anxiety from 44% to 21%. In addition, the rehabilitation program reduced the occurrence of subjective ailments such as chest pain (from 68% to 10%), fatigue (from 40% to 33%), and dyspnea (from 50% to 12%).

CONCLUSIONS

Despite the achievement of quality of life improvements among patients after surgery coronary artery by-pass grafting and early cardiac rehabilitation, the result is not fully satisfactory. Systematic treatment and education should be continued to further improve the health of patients.

Discharge Planning After Myocardial Revascularization: Differences in Opinions From Patients and Health Experts

BACKGROUND

In-hospital education and discharge planning contribute to recovery after coronary artery bypass graft surgery (CABG).

OBJECTIVE

The objective of this study was to identify differences in perception of the importance of discharge instructions between a sample of adult patients after CABG and health experts responsible for their care.

METHODS

Thirty-five first-time CABG adult patients and 8 multidisciplinary experts rated a 46-item questionnaire of discharge education themes on a 3-point scale. Items were classified as most important if rated as "very important" by more than 85% of the participants in each group.

RESULTS

Of the 31 items considered most important (reaching the 85% approval criteria), agreement between groups was reached for 15 (48%), whereas 11 (35%) items were selected only by the patients and 5 (16%) were selected only by the experts.

CONCLUSIONS

The authors of this study demonstrate a difference in perception between patients and health experts regarding the importance of various discharge instructions. Better understanding areas of patient concern may improve discharge routines.

Common experiences of patients following suboptimal treatment outcomes: implications for epilepsy surgery

Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals. Twenty-two studies were found of patients experiencing a range of suboptimal outcomes, including seizure recurrence, cancer recurrence and progression, unsuccessful joint replacement, unsuccessful infertility treatment, organ transplant rejection, coronary bypass graft surgery, and unsuccessful weight-loss surgery. In order of frequency, the most common patient experiences included the following: altered social dynamics and stigma, unmet expectations, negative emotions, use of coping strategies, hope and optimism, perceived failure of the treating team, psychiatric symptoms, and control issues. There is support in the epilepsy surgery literature that unmet expectations and psychiatric symptoms are key issues for patients with seizure recurrence, while other common patient experiences have been implied but not systematically examined. Several epilepsy surgery specific factors influence patient perceptions of seizure recurrence, including the nature of postoperative seizures, the presence of postoperative complications, and the need for increased postoperative medications. Knowledge of common patient experiences can assist in the delivery of patient follow-up and rehabilitation services tailored to differing outcomes after epilepsy surgery.

Predictors of anxiety symptoms in the gynecological outpatient setting: The Thai experience

Objective. To examine the prevalence and predictors of anxiety in women attending a gynecological outpatient service. Method. A total of 271 women who came to a gynecological outpatient clinic at a large university hospital in Bangkok, Thailand, were asked to complete the state sub-scale of the Spielberger State-Trait Anxiety Index (STAI) and a questionnaire to obtain demographic, medical and gynecological information as well as a questionnaire to assess social support. A cutoff score of ≥ 46 on the STAI was considered to indicate the presence of moderate-severe anxiety. Result. One hundred (36.9%) subjects met criteria for anxiety. Anxious women were more likely to be young and to have had an abortion at an earlier age. They were more likely to reside in rural Thailand, report perception of low social support, present with abnormal vaginal discharge and to have a greater number of gynecological symptoms than non-anxious women. Additionally, anxious women were less likely to have knowledge about their diagnosis compared to non-anxious women. Conclusion. Clinically meaningful levels of anxiety are common among women attending an outpatient gynecological clinic. Awareness of risk factors for anxiety in these women will aid medical personnel in identifying those in need of additional support and/or mental health services.