title: Coronary artery bypass graft surgery: exploring a broader perspective of risks and outcomes.
abstract: Although the literature is replete with evidence related to physiological predictors and short-term outcomes of coronary artery bypass graft (CABG) surgery, there is still a paucity of data that encompass a broader perspective of risk and outcomes. The primary objective of this prospective cohort study was to explore the physiological and psychosocial dimensions of preoperative status that may be predictive of the short- and longer term outcomes of CABG surgery. Patients (N = 136) scheduled for elective/urgent CABG surgery were followed from the time of placement on the waiting list until 6 months after the surgery. Significant predictors of intensive care unit length of stay (LOS) included the following: age, urgency of operation, and perioperative complications. Hospital LOS was best predicted by baseline unemployment, longer bypass time, and perioperative complications. Baseline unemployment and less optimism regarding surgery outcomes were predictive of postdischarge home care utilization. Lower baseline physical functioning predicted postdischarge emergency room visits. Sex and baseline mental status predicted quality of life/health satisfaction scores at 6 weeks and 6 months after discharge. The ability to predict patient outcomes has implications for program planning, patient education, and policy development. The findings of this study provide rationale for clinicians, educators, and administrators to consider a broader scope of physiological and psychosocial parameters to predict outcomes of CABG surgery. Although the sample size was relatively small, the broader perspective on risk and outcomes provides insight for strategies to optimize overall outcomes for the CABG surgery population. These findings also establish the cornerstone for ongoing CABG surgery outcomes evaluation and research.
authors.affiliation: Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada. joanne_sawatzky@umanitoba.ca
authors.forename: Jo-Ann V
authors.initials: JA
authors.lastname: Sawatzky
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Naimark
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D001294:Attitude to Health; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008603:Mental Health; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000523:psychology