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Raidou V, Mitete K, Kourek C, Antonopoulos M, Soulele T, Kolovou K, Vlahodimitris I, Vasileiadis I, Dimopoulos S. Quality of life and functional capacity in patients after cardiac surgery intensive care unit. World J Cardiol 2024; 16:436-447. [PMID: 39221189 PMCID: PMC11362807 DOI: 10.4330/wjc.v16.i8.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 06/24/2024] [Accepted: 07/22/2024] [Indexed: 08/26/2024] Open
Abstract
Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide, leading to morbidity and mortality. Coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) have therapeutic benefits, including improved postoperative quality of life (QoL) and enhanced patient functional capacity which are key indicators of cardiac surgery outcome. In this article, we review the latest studies of QoL outcomes and functional capacity in patients who underwent cardiac surgery. Many standardized instruments are used to evaluate QoL and functional conditions. Preoperative health status, age, length of intensive care unit stay, operative risk, type of procedure, and other pre-, intra-, and postoperative factors affect postoperative QoL. Elderly patients experience impaired physical status soon after cardiac surgery, but it improves in the following period. CABG and SAVR are associated with increases of physical and mental health and functional capacity in the immediate postoperative and the long long-term. Cardiac rehabilitation improves patient functional capacity, QoL, and frailty following cardiac surgery.
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Affiliation(s)
- Vasiliki Raidou
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Katerina Mitete
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Christos Kourek
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Michael Antonopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Theodora Soulele
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Kyriaki Kolovou
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Ioannis Vlahodimitris
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Ioannis Vasileiadis
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece.
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Li R. Dependent functional status is an independent risk factor for 30-day mortality and morbidities following colectomy for volvulus: An ACS-NSQIP study from the United States. Clin Res Hepatol Gastroenterol 2024; 48:102391. [PMID: 38834098 DOI: 10.1016/j.clinre.2024.102391] [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: 05/18/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES Colonic volvulus is a common cause of bowel obstructions and surgery is the definitive treatment. Functional status is often associated with adverse postoperative outcomes but its effect on colectomy for volvulus remained under-explored. This study sought to analyze the effect of functional status on the 30-day outcomes of colectomy for volvulus. MATERIALS AND METHOD National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Only patients with volvulus as the primary indication for colectomy were included. Thirty-day postoperative outcomes were compared between patients with dependent functional status (DFS) and independent functional status (IFS), adjusted for demographics, baseline characteristics, preoperative preparation, indication for surgery, and operative approaches by multivariable logistic regression. RESULTS There were 1,476 patients with DFS (945 partially DFS and 531 fully DFS) and 8,824 (85.67 %) IFS patients who underwent colectomy for volvulus. After multivariable analysis, DFS patients had higher risks of mortality (aOR=1.671, 95 CI=1.37-2.038, p < 0.01), pulmonary complications (aOR=2.166, 95 CI=1.85-2.536, p < 0.01), sepsis (aOR=1.31, 95 CI=1.107-1.551, p < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR=1.436, 95 CI=1.269-1.626, p < 0.01), discharge not to home (aOR=3.774, 95 CI=3.23-4.411, p < 0.01), and 30-day readmission (aOR=1.196, 95 CI=1.007-1.42, p = 0.04). Moreover, DFS patients had a longer length of stay (p = 0.01). CONCLUSION DFS was identified as an independent risk factor for increased mortality and complications after colectomy for volvulus. Given the substantial overlap between DFS patients and those who have colonic volvulus, these insights can contribute to preoperative risk assessments and postoperative care in these patients.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, United States.
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Saha S, Mladenova R, Radner C, Horke KM, Buech J, Schnackenburg P, Ali A, Peterss S, Juchem G, Luehr M, Hagl C, Joskowiak D. Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis. J Clin Med 2022; 11:jcm11133599. [PMID: 35806881 PMCID: PMC9267565 DOI: 10.3390/jcm11133599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/12/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: The objective of this study was to compare the long-term outcomes and health-related quality of life (HRQOL) of patients following surgery for infective native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Methods: We retrospectively identified 633 consecutive patients who had undergone surgery for infective endocarditis at our center between January 2005 and October 2018. The patients were interviewed, and the SF-36 survey was used to assess the HRQOL of survivors. Propensity score matching (2:1) was performed with data from a German reference population. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model. Results: The median age of the cohort was 67 (55–74) years, and 75.6% were male. Operative mortality was 13.7% in the NVE group and 21.6% in the PVE group (p = 0.010). The overall survival at 1 year was 88.0% and was comparable between the groups. The physical health summary scores were 49 (40–55) for the NVE patients and 45 (37–52) for the PVE patients (p = 0.043). The median mental health summary scores were 52 (35–57) and 49 (41–56), respectively (p = 0.961). On comparison of the HRQOL to the reference population, the physical health summary scores were comparable. However, significant differences were observed with regard to the mental health summary scores (p = 0.005). Conclusions: Our study shows that there are significant differences in the various domains of HRQOL, not only between NVE and PVE patients, but also in comparison to healthy individuals. In addition to preoperative health status, it is important to consider the patient’s expectations regarding surgery. Further prospective studies are required.
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Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
- Correspondence: author:
| | - Ralitsa Mladenova
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
| | - Caroline Radner
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Konstanze Maria Horke
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Philipp Schnackenburg
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Ahmad Ali
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Maximilian Luehr
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
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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] [MESH Headings] [Grants] [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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