Health-related quality of life after coronary artery bypass grafting: a gender analysis using the Duke Activity Status Index.
OBJECTIVE
Our objectives were to document the preoperative and postoperative functional status of patients undergoing coronary artery bypass grafting, to examine factors that influence functional recovery, and to determine whether gender differences exist in the preoperative and postoperative functional status with the Duke Activity Status Index.


METHODS
One thousand eight hundred twenty-five patients undergoing isolated coronary artery bypass grafting had baseline and follow-up quality-of-life surveys. Mean follow-up from baseline to postoperative Duke Activity Status Index was 8.0 months for women and men. The influence of 47 variables, in addition to baseline scores on postoperative functional status, was examined with logistic ordinal modeling. An ordinal model for the follow-up score was determined by means of backward selection, with variables retained if they satisfied the criterion of a P value of less than.05.


RESULTS
Median baseline Duke Activity Status Index scores (women, 21.5; men, 32.2; P <.001) and first follow-up scores (women, 42.7; men, 58.2; P <.001) were lower in women than in men. Patients who were older and those who had chronic obstructive pulmonary disease, myocardial infarction, stroke, diabetes, vascular disease, postoperative serious infection, and return to the operating room had lower postoperative scores. After adjusting for these factors, women still had lower follow-up scores (odds ratio for men, 2.1 [95% confidence interval, 1.7-2.6]; P <.001).


CONCLUSIONS
A number of preoperative factors, operative variables, and postoperative events are associated with functional recovery after coronary revascularization. In addition, female gender is associated with more postoperative functional impairment after adjusting for these perioperative variables.
Koch
Colleen Gorman
CG
Department of Cardiothoracic Anesthesia (G-3), The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. kochc@ccf.org
Khandwala
Farah
F
Cywinski
Jacek B
JB
Ishwaran
Hemant
H
Estafanous
Fawzy G
FG
Loop
Floyd D
FD
Blackstone
Eugene H
EH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D012737:Sex Factors; D011795:Surveys and Questionnaires