title: Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery.
abstract: The present study examined the association between patient-reported anxiety and postcardiac surgery mortality and major morbidity. Frailty Assessment Before Cardiac Surgery was a prospective multicenter cohort study of elderly patients undergoing cardiac surgery (coronary artery bypass surgery and/or valve repair or replacement) at 4 tertiary care hospitals from 2008 to 2009. The patients were evaluated a mean of 2 days preoperatively with the Hospital Anxiety and Depression Scale, a validated questionnaire assessing depression and anxiety in hospitalized patients. The primary predictor variable was a high level of anxiety, defined by a Hospital Anxiety and Depression Scale score of ≥ 11. The main outcome measure was all-cause mortality or major morbidity (e.g., stroke, renal failure, prolonged ventilation, deep sternal wound infection, or reoperation) occurring during the index hospitalization. Multivariable logistic regression analysis examined the association between high preoperative anxiety and all-cause mortality/major morbidity, adjusting for the Society of Thoracic Surgeons predicted risk, age, gender, and depression symptoms. A total of 148 patients (mean age 75.8 ± 4.4 years; 34% women) completed the Hospital Anxiety and Depression Scale. High levels of preoperative anxiety were present in 7% of patients. No differences were found in the type of surgery and Society of Thoracic Surgeons predicted risk across the preoperative levels of anxiety. After adjusting for potential confounders, high preoperative anxiety was remained independently predictive of postoperative mortality or major morbidity (odds ratio 5.1, 95% confidence interval 1.3 to 20.2; p = 0.02). In conclusion, although high levels of anxiety were present in few patients anticipating cardiac surgery, this conferred a strong and independent heightened risk of mortality or major morbidity.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Morin
authors.forename: Yves
authors.initials: Y
authors.lastname: Langlois
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.forename: Kim
authors.initials: K
authors.lastname: Smolderen
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.forename: Howard
authors.initials: H
authors.lastname: Bergman
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.forename: Jonathan
authors.initials: J
authors.lastname: Afilalo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D057234:Preoperative Period; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology