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Smoor RM, van Dongen EPA, Daeter EJ, Emmelot-Vonk MH, Cremer OL, Vernooij LM, Noordzij PG. The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2024; 168:608-616.e5. [PMID: 37302466 DOI: 10.1016/j.jtcvs.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the influence of preoperative multidisciplinary team (MDT) care on perioperative management and outcomes of frail patients undergoing cardiac surgery. BACKGROUND Frail patients are at increased risk for complications and poor functional outcome after cardiac surgery. In these patients, preoperative MDT care may improve outcomes. METHODS Between 2018 and 2021, 1168 patients aged 70 years or older were scheduled for cardiac surgery, of whom 98 (8.4%) frail patients were referred for MDT care. The MDT discussed surgical risk, prehabilitation, and alternative treatment. Outcomes of MDT patients were compared with 183 frail patients (non-MDT group) from a historical study cohort (2015-2017). Inverse probability of treatment weighting was used to minimize bias from nonrandom allocation of MDT versus non-MDT care. Outcomes were severe postoperative complications, total days in hospital after 120 days, disability, and health-related quality of life after 120 days. RESULTS This study included 281 patients (98 MDT and 183 non-MDT patients). Of the MDT patients, 67 (68%) had open surgery, 21 (21%) underwent minimally invasive procedures, and 10 (10%) received conservative treatment. In the non-MDT group, all patients had open surgery. Fourteen (14%) MDT patients experienced a severe complication versus 42 (23%) non-MDT patients (adjusted relative risk, 0.76; 95% CI, 0.51-0.99). Adjusted total days in hospital after 120 days was 8 days (interquartile range, 3-12 days) versus 11 days (interquartile range, 7-16 days) for MDT and non-MDT patients, respectively (P = .01). There was no difference in disability or health-related quality of life. CONCLUSIONS Preoperative MDT care for frail patients undergoing cardiac surgery is associated with alterations in surgical management and with a lower risk for severe complications.
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Affiliation(s)
- Rosa M Smoor
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eric P A van Dongen
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Edgar J Daeter
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marielle H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisette M Vernooij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
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Rijnhart-de Jong HG, Haenen J, Porta F, Timmermans M, Boerma EC, de Jong K. Hospital infections and health-related quality of life after cardiac surgery: a multicenter survey. J Cardiothorac Surg 2024; 19:84. [PMID: 38336817 PMCID: PMC10858541 DOI: 10.1186/s13019-024-02559-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Recent research suggested that hospital infections are a predictive marker for physical non-recovery one year after cardiothoracic surgery. The purpose of this study was to explore whether this risk factor is etiologic. Additional, the influence of a potential effect modifying factor, diabetes mellitus, was investigated. METHODS In this multicenter study, patients underwent elective or urgent cardiothoracic surgery between 01-01-2015 and 31-12-2019, and completed pre- and one year post-operative Short Form Health Survey 36/12 quality of life questionnaires. A binary logistic regression model, in which the inverse of the propensity score for infection risk was included as a weight variable, was used. Second, this analysis was stratified for diabetes mellitus status. RESULTS 8577 patients were included. After weighing for the propensity score, the standardized mean differences of all variables decreased and indicated sufficient balance between the infection and non-infection groups. Hospital infections were found to be a risk factor for non-recovery after cardiothoracic surgery in the original and imputed dataset before weighting. However, after propensity score weighing, hospital infections did not remain significantly associated with recovery (OR for recovery = 0.79; 95% CI [0.60-1.03]; p = 0.077). No significant interaction between diabetes mellitus and hospital infections on recovery was found (p = 0.845). CONCLUSIONS This study could not convincingly establish hospital infections as an etiologic risk factor for non-improvement of physical recovery in patients who underwent cardiothoracic surgery. In addition, there was no differential effect of hospital infections on non-improvement of physical recovery for patients with and without diabetes mellitus. Trial registration International Clinical Trials Registry Platform ID NL9818; date of registration, 22-10-2021 ( https://trialsearch.who.int/ ).
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Affiliation(s)
- Hilda G Rijnhart-de Jong
- Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934 AD, The Netherlands.
- Department of Intensive Care, Leeuwarden Medical Centre, Leeuwarden, The Netherlands.
| | - Jo Haenen
- Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934 AD, The Netherlands
| | - Fabiano Porta
- Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934 AD, The Netherlands
| | | | - E Christiaan Boerma
- Department of Intensive Care, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
- Department of Sustainable Health, Rijksuniversiteit Groningen, Campus Fryslân Leeuwarden, Leeuwarden, The Netherlands
| | - Kim de Jong
- Department of Epidemiology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
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Borregaard B, Bruvik SM, Dahl J, Ekholm O, Bekker-Jensen D, Sibilitz KL, Zwisler AD, Lauck SB, Pedersen SS, Norekvål T, Riber LPS, Møller JE. Psychometric Properties of the Kansas City Cardiomyopathy Questionnaire in a Surgical Population of Patients With Aortic Valve Stenosis. Am J Cardiol 2023; 209:165-172. [PMID: 37898098 DOI: 10.1016/j.amjcard.2023.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/30/2023]
Abstract
The 12-item version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) was originally developed for patients with heart failure but has been used and tested among patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation. Whether the instrument is suitable for patients with AS who underwent surgical aortic valve replacement (SAVR) is currently unknown. Thus, we aimed to investigate the psychometric properties of the KCCQ-12 before and after SAVR among patients with severe AS. We conducted a prospective cohort of 184 patients with AS who completed the KCCQ-12 and the EuroQol 5 Dimension 5 Levels before and 4 weeks after surgery. Construct validity was investigated with hypothesis testing and an analysis of Spearman's correlation between the two instruments. Structural validity was investigated with explorative and confirmatory factor analyses and reliability with Cronbach's α. All analyses were conducted on data from the two time points (preoperatively and four weeks after surgery). The hypothesis testing revealed how the New York Heart Association class was significantly correlated with the preoperative KCCQ-12 total score (higher New York Heart Association class, worse score). A longer length of hospital stay and living alone were significantly associated with poorer postoperative KCCQ-12 total score. KCCQ-12 and EuroQol 5 Dimension 5 Levels were moderately correlated in most domains/the total score/Visual Analogue Scale score. Principal component analyses revealed two 3-factor structures. The confirmatory factor analyses did not support the original model at any time point. Cronbach's α ranged from 0.22 to 0.84 in three preoperative factors and from 0.39 to 0.76 in the postoperative factors. The total Cronbach's α was 0.83 for the suggested preoperative 3-factor model and 0.83 for the postoperative model. In conclusion, the Danish version of the KCCQ-12 tested in a population of patients with AS who underwent SAVR appears to have acceptable construct validity, whereas structural validity cannot be confirmed for the original four-factor model. Overall reliability is good.
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Affiliation(s)
- Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | | | - Jordi Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | | | - Ann Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark; Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | - Sandra B Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Tone Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Lars P Schødt Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Hämäläinen L, Kohonen M, Laurikka J. Health-related quality of life is improved after coronary artery bypass graft surgery: a 1-year follow-up study. SCAND CARDIOVASC J 2023; 57:2284083. [PMID: 38010887 DOI: 10.1080/14017431.2023.2284083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 11/11/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The purpose of this study was to detect changes in QoL after coronary artery bypass grafting surgeries (CABG) in one year, and to identify the possible predictive factors associated with the change. DESIGN A single-center prospective study of 501 patients was conducted between 2013 and 2018 using the EQ-5D VAS questionnaire for estimating the QoL. The patients filled in a questionnaire preoperatively, at 6 and at 12 months postoperatively. Univariate and multivariable logistic regression analyses were used to find out if certain pre-selected factors or EQ5D dimensions had independent effects on the observed EQ VAS scores. RESULTS QoL improved in all EQ-5D dimensions and in EQ VAS scores at 6 and at 12 months: the greatest changes in the number of reported problems were in the dimensions "mobility" (-34.2%, p<.001), "self-care" (-36.7%, p=.001) and "pain or discomfort" (-31.0%, p<.001). With the multivariable regression model, we could show that normal left ventricle ejection fraction (LVEF) and improvement in mobility and pain/discomfort dimensions were in association with improvement of EQ VAS score at 6 months. At 12 months this association was no longer detectable. CONCLUSIONS CABG procedure can improve patient's QoL when judged with EQ5D dimensions and related overall self-rated health (VAS). This improvement was seen both at 6 and at 12 months postoperatively. Except for LVEF, the other patient-specific risk factors we examined did not seem to affect QoL in the long term.
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Affiliation(s)
- Laura Hämäläinen
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Mika Kohonen
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Jari Laurikka
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Tampere University Hospital Heart Center, Tampere, Finland
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Kim H, Bae SH, Lim SH, Park JH. Predictors of health-related quality of life after coronary artery bypass graft surgery. Sci Rep 2022; 12:16119. [PMID: 36167788 PMCID: PMC9515078 DOI: 10.1038/s41598-022-20414-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
Health-related quality of life (HRQOL) is a multifactorial concept in assessing physical and mental health. This study was performed to evaluate the HRQOL of patients undergoing coronary artery bypass graft (CABG) surgery and the predictors of HRQOL in patients until 1 year after surgery. This cross-sectional study included 110 consecutive patients who underwent elective CABG in a medical center in South Korea. The Short-Form Health Survey, cardiac symptom survey, cardiac self-efficacy, and the Interpersonal Support Evaluation List-12 were used to measure the HRQOL, symptom experience, self-efficacy, and social support, respectively. The regression model explained 42% of the variance in the participants' physical HRQOL. The predictors of the physical HRQOL include the presence of a spouse, post-CABG duration, symptom experience, and self-efficacy. The regression model explained 36% of the variance in the participants' mental HRQOL. The predictors of the mental HRQOL included perceived health status, self-efficacy, and social support. The predictive factors for HRQOL after CABG were the presence of a spouse, post-CABG duration, symptom experience, self-efficacy, and social support. Furthermore, a suitable program and nursing interventions could be implemented to improve the HRQOL of post-CABG patients.
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Affiliation(s)
- Hwasoon Kim
- College of Nursing, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Sun Hyoung Bae
- College of Nursing, Research Institute of Nursing Science, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Sang-Hyun Lim
- Department of Thoracic & Cardiovascular Surgery, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea
| | - Jin-Hee Park
- College of Nursing, Research Institute of Nursing Science, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon, Republic of Korea.
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Sanders J, Bowden T, Woolfe-Loftus N, Sekhon M, Aitken LM. Predictors of health-related quality of life after cardiac surgery: a systematic review. Health Qual Life Outcomes 2022; 20:79. [PMID: 35585633 PMCID: PMC9118761 DOI: 10.1186/s12955-022-01980-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients' perspective. AIMS To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted. METHODS Electronic databases (including MEDLINE, CINAHL, Embase) were searched between January 2001 and December 2020 for studies determining predictors of HRQoL (using a recognised and validated tool) in adult patients undergoing cardiac surgery. Data extraction and quality assessments were undertaken and data was summarised using descriptive statistics and narrative synthesis, as appropriate. RESULTS Overall, 3924 papers were screened with 41 papers included in the review. Considerable methodological heterogeneity between studies was observed. Most were single-centre (75.6%) prospective observational studies (73.2%) conducted in patients undergoing coronary artery bypass graft (CABG) (n = 51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent predictors (62 pre-operative, five intra-operative and 36 post-operative) were identified, where 34 (33.0%) were reported in more than one study. Potential pre-operative modifiable predictors include alcohol use, BMI/weight, depression, pre-operative quality of life and smoking while in the post-operative period pain and strategies to reduce post-operative complications and intensive care and hospital length of stay are potential therapeutic targets. CONCLUSION Despite a lack of consistency across studies, several potentially modifiable predictors were identified that could be targeted in interventions to improve patient or treatment outcomes. This may contribute to delivering more person-centred care involving shared decision-making to improve patient HRQoL after cardiac surgery.
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Affiliation(s)
- Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7DN, UK. .,William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London, EC1M 6BQ, UK.
| | - Tracey Bowden
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Nicholas Woolfe-Loftus
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7DN, UK
| | - Mandeep Sekhon
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, 4111, Australia
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