Verwijmeren Lisa, Noordzij Peter Gerben, Daeter Edgar Jozeph, van Zaane Bas, Peelen Linda Margaretha, van Dongen Eric Paulus Adrianus
Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands.
Cardiac Surgery, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands.
J Cardiothorac Surg. 2018 Nov 19;13(1):118. doi: 10.1186/s13019-018-0798-2.
Health related quality of life (HRQL) is an important patient related outcome measure after cardiac surgery. Preoperative determinants for postoperative HRQL have not yet been identified, but could aid in preoperative decision making. The aim of this article is to identify associations between preoperative determinants and change in HRQL 1 year after coronary artery bypass grafting (CABG).
Single centre retrospective cohort study in 658 patients. Change in HRQL was defined as a decrease or increase of ≥5 points on the physical or mental domain of the Short Form 12 (SF-12) questionnaire. Patients were stratified in three groups according to worse, unchanged, or better HRQL. Multinomial logistic regression analysis was used to investigate the association between preoperative risk factors and postoperative change in HRQL.
Physical HRQL improved in 22.8% of patients, did not change in 61.2% of patients and worsened in 16.0% of patients. Comorbidities associated with change in physical HRQL were a history of stroke, atrial fibrillation, vascular disease or pulmonary disease. Most important risk factor for change in physical HRQL was preoperative HRQL. Higher preoperative SF-12 score decreased the odds for worse physical HRQL and increased the odds for better physical HRQL. Mental HRQL improved in 49.8% of patients, remained unchanged in 34.5% of patients and worsened in 15.7% of patients. Preoperative HRQL was an important risk factor for a change in mental HRQL. Higher preoperative physical HRQL increased the odds for improved mental HRQL. Lower preoperative mental HRQL increased the odds for better mental HRQL.
One year after CABG the majority of patients experiences equal or improved HRQL compared to before surgery. Most important preoperative risk factor for change in HRQL is preoperative HRQL.
健康相关生活质量（HRQL）是心脏手术后一项重要的患者相关结局指标。术后HRQL的术前决定因素尚未明确，但可能有助于术前决策。本文旨在确定冠状动脉旁路移植术（CABG）后1年术前决定因素与HRQL变化之间的关联。
对658例患者进行单中心回顾性队列研究。HRQL变化定义为简短健康调查问卷（SF-12）身体或心理领域得分下降或增加≥5分。根据HRQL变差、不变或变好，将患者分为三组。采用多项逻辑回归分析研究术前危险因素与术后HRQL变化之间的关联。
22.8%的患者身体HRQL改善，61.2%的患者无变化，16.0%的患者变差。与身体HRQL变化相关的合并症包括中风史、心房颤动、血管疾病或肺部疾病。身体HRQL变化的最重要危险因素是术前HRQL。术前SF-12评分越高，身体HRQL变差的几率越低，身体HRQL变好的几率越高。49.8%的患者心理HRQL改善，34.5%的患者保持不变，15.7%的患者变差。术前HRQL是心理HRQL变化的重要危险因素。术前身体HRQL越高，心理HRQL改善的几率越高。术前心理HRQL越低，心理HRQL变好的几率越高。
CABG术后1年，大多数患者的HRQL与手术前相比保持不变或有所改善。HRQL变化的最重要术前危险因素是术前HRQL。
