Norkienė Ieva, Urbanaviciute Indre, Kezyte Greta, Vicka Vaidas, Jovaisa Tomas
Faculty of Medicine, Clinic of Anaesthesiology and Reanimatology, Vilnius University, Vilnius, Lithuania.
Clinic of Anaesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
ANZ J Surg. 2018 Apr;88(4):332-336. doi: 10.1111/ans.14061. Epub 2017 Jul 12.
Long-term improvement in health-related quality of life (HRQOL) is one of the most important outcomes of cardiac surgery. The aim of this study is to define the impact of perioperative patient and procedural variables on HRQOL dynamics, a year after cardiac surgery.
Consecutive patients undergoing elective on-pump cardiac surgery were enrolled in this prospective observational cohort study. Patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire a day before surgery and once again a year after surgery. The effect size method was used to determine whether treatment resulted in the improvement of HRQOL.
A total of 67.3% of patients achieved long-term improvement in HRQOL. Significant negative association was identified between Physical and Mental Component Summary scores (PCS/MCS) and long-term outcomes. Pre-operative PCS were 40.7 ± 13.7 for improvers and 56.6 ± 14.4 for non-improvers; MCS were 45.8 ± 12.1 and 65.2 ± 13.7, respectively (P < 0.001 for all). There were no statistically significant differences in pre-operative risk factors, demographics, operative factors or post-operative variables between the two groups.
Among those completing this study, one in three patients did not experience long-term HRQOL improvements following cardiac surgery. Multivariate analysis confirmed that higher pre-operative PCS and MCS are independent predictors of worse HRQOL a year after surgery. Further research should focus on establishing the prevalence of this phenomenon worldwide and develop targeted interventions to improve long-term self-perceived quality of life for patients with relatively good pre-operative health.
健康相关生活质量（HRQOL）的长期改善是心脏手术最重要的结果之一。本研究的目的是确定围手术期患者和手术变量对心脏手术后一年HRQOL动态变化的影响。
本前瞻性观察队列研究纳入了连续接受择期体外循环心脏手术的患者。患者在手术前一天和手术后一年分别完成医学结局研究36项简短健康调查（SF-36）问卷。采用效应量方法确定治疗是否导致HRQOL改善。
共有67.3%的患者实现了HRQOL的长期改善。身体和心理成分汇总得分（PCS/MCS）与长期结局之间存在显著的负相关。改善组术前PCS为40.7±13.7，未改善组为56.6±14.4；MCS分别为45.8±12.1和65.2±13.7（所有P<0.001）。两组之间术前危险因素、人口统计学、手术因素或术后变量无统计学显著差异。
在完成本研究的患者中，三分之一的患者在心脏手术后未经历HRQOL的长期改善。多变量分析证实，较高的术前PCS和MCS是术后一年HRQOL较差的独立预测因素。进一步的研究应侧重于确定这种现象在全球的患病率，并制定有针对性的干预措施，以改善术前健康状况相对良好的患者的长期自我感知生活质量。
