Change in Functional Status from Preoperative to One Year Postoperative in Patients Who Have Undergone Elective Open-Heart Surgery: A Repeated-Measures Study
Purpose:Although patient-related factors affect surgical outcomes, preoperative functional status is not measured by any cardiac risk score. Functional status can, however, be objectively measured using validated outcome tools such as the Late-LifeFunctionandDisabilityInstrument (LLFDI). The purpose of this study was to determine 1) if there was a change over time in functional status, as measured by the LLFDI, in patients who underwent elective cardiac surgery, and if so, 2) what specific aspect(s) of functional status changed.Methods:A prospective longitudinal study of one year was conducted on elective cardiac surgery patients (n = 43) using the self-reported LLFDI, which measures Disability Frequency (frequency of participation in social tasks), Disability Limitation (ability to participate in social tasks) and Function Total (ease in performing routine activities). Higher scores indicate increased function and decreased disability. LLFDI scores were compared at three times (preoperative, six-week and one-year postoperative) using repeated measures ANOVA. Post hoc pairwise comparison was conducted for specific interactions. Results: Both Function Total and Disability Frequency significantly changed over time (p = 0.047 and p = 0.013, respectively). Specifically, patients’ function level was significantly higher one-year postoperative compared to preoperative (M difference = +3.48, SE = 1.48, p = 0.026). Likewise, Disability Frequency scores were significantly higher (i.e. more active) at one-year postoperative versus preoperative (M difference= +5.98, SE = 2.19, p = 0.033). Disability Limitation scores were not significantly different between any time points (p > 0.05). Conclusion:By one-year postoperative, patients demonstrated increased ease in their routine physical activities and were more participatory in social life tasks. Individuals who underwent elective cardiac surgery took more than six weeks to detect notable improvement in functional status, which was expected with a sternotomy approach. This study provides support for the use of the LLFDI as an effective tool to capture functional status in the cardiac population. These findings may assist cardiac patients in recovery timeline expectations.
References
[1]
Weisel, R.D., Nussmeier, N., Newman, M.F., et al. (2014) Predictors of Contemporary Coronary Artery Bypass Grafting Outcomes. The Journal of Thoracic and Cardiovascular Surgery, 148, 2720-2726. https://doi.org/10.1016/j.jtcvs.2014.08.018
[2]
Kusu-Orkar, T.E., Kermali, M., Oguamanam, N., Bithas, C. and Harky, A. (2020) Coronary Artery Bypass Grafting: Factors Affecting Outcomes.Journal of Cardiac Surgery, 35, 3503-3511. https://doi.org/10.1111/jocs.15013
[3]
Jones, J.M., Loubani, M., Grant, S.W., etal.(2022) Cardiac Surgery in Older Patients: Hospital Outcomes during a 15-Year Period from a Complete National Series.Interactive CardioVascular and Thoracic Surgery, 34, 532-539. https://doi.org/10.1093/icvts/ivab320
[4]
Akins, C.W., Miller, C., Turina, M.I., etal(2008) Guidelines for Reporting Mortality and Morbidity after Cardiac Valve Interventions.The Annals of Thoracic Surgery, 85, 1490-1495. https://doi.org/10.1016/j.athoracsur.2007.12.082
[5]
Ferguson, T.B., Hammill, B.G., Peterson, E.D., DeLong, E.R. and Grover, F.L. (2002) A Decade of Change–Risk Profiles and Outcomes for Isolated Coronary Bypass Grafting Procedures, 1990-1999: A Report from the STS National Database Committee and the Duke Clinical Research Institute. The Annals of Thoracic Surgery, 73,480-490. https://doi.org/10.1016/S0003-4975(01)03339-2
[6]
Shahian, D.M., O’Brien, S.M., Filardo, G., etal. (2009) The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models: Part 1—Coronary Artery Bypass Grafting Surgery.The Annals of Thoracic Surgery, 88, S2-S22. https://doi.org/10.1016/j.athoracsur.2009.05.053
[7]
Shahian, D.M., O’Brien, S.M., Filardo, G., etal. (2009) The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models, Part 3: Valve plus Coronary Artery Bypass Grafting Surgery. The Annals of Thoracic Surgery, 88, S43-S62. https://doi.org/10.1016/j.athoracsur.2009.05.055
[8]
Jacobs, J.P., Shahian, D.M., Badhwar, V., etal. (2022) The Society of Thoracic Surgeons 2021 Adult Cardiac Surgery Risk Models for Multiple Valve Operations.The Annals of Thoracic Surgery, 113, 511-518. https://doi.org/10.1016/j.athoracsur.2021.03.089
[9]
Lawton, J.S., Tamis-Holland, J.E., Bangalore, S., etal. (2022) 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145, e4-e17. https://doi.org/10.1161/CIR.0000000000001039
[10]
Nashef, S.A., Roques, F., Sharples, L.D., et al. (2012) EuroSCORE II. European Journal of Cardio-Thoracic Surgery, 41, 734-745. https://doi.org/10.1093/ejcts/ezs043
[11]
Silverborn, M., Nielsen, S., Karlsson, M., et al. (2023) The Performance of EuroSCORE II in CABG Patients in Relation to Sex, Age, and Surgical Risk: A Nationwide Study in 14,118 Patients. Journal of Cardiothoracic Surgery, 18, Article No. 40. https://doi.org/10.1186/s13019-023-02141-4
[12]
Bouabdallaoui, N., Stevens, S.R., Doenst, T.,et al. (2018) Society of Thoracic Surgeons Risk Score and EuroSCORE-2 Appropriately Assess 30-Day Postoperative Mortality in the STICH Trial and a Contemporary Cohort of Patients with Left Ventricular Dysfunction Undergoing Surgical Revascularization. Circulation: Heart Failure, 11, e005531. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005531
[13]
Sepehri, A., Beggs, T., Hassan, A., et al. (2014). The Impact of Frailty on Outcomes after Cardiac Surgery: A Systematic Review. The Journal of Thoracic and Cardiovascular Surgery, 148, 3110-3117. https://doi.org/10.1016/j.jtcvs.2014.07.087
[14]
Afilalo, J., Mottillo, S., Eisenberg, M.J., et al. (2012). Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity. Circulation: Cardiovascular Quality and Outcomes, 5, 222-228. https://doi.org/10.1161/CIRCOUTCOMES.111.963157
[15]
Bäck, C., Hornum, M., Jørgensen, M.B., Lorenzen, U.S., Olsen, P.S. and Møller, C.H. (2021) Comprehensive Assessment of Frailty Score Supplements the Existing Cardiac Surgical Risk Scores. European Journal of Cardio-Thoracic Surgery, 60, 710-716. https://doi.org/10.1093/ejcts/ezab127
[16]
Yanagawa, B., Graham, M.M., Afilalo, J., Hassan, A. and Arora, R.C. (2018) Frailty as a Risk Predictor in Cardiac Surgery: Beyond the Eyeball Test. Journal of Thoracic and Cardiovascular Surgery, 156, 172-176. https://doi.org/10.1016/j.jtcvs.2018.01.103
[17]
Barac, Y.D., Josefson, E.K., Saute, M., Gorphil, D., Rubchevsky, V. and Aravot, D. (2019) Comprehensive Assessment of Frailty Score as a Tool to Assess Potential Recovery in Cardiac Surgery. Journal of Thoracic and Cardiovascular Surgery, 158, E43-E44. https://doi.org/10.1016/j.jtcvs.2019.02.118
[18]
Varley, P.R., Buchanan, D., Bilderback, A., et al. (2023). Association of Routine Preoperative Frailty Assessment with 1-Year Postoperative Mortality. The Journal of American Medical Association Surgery, 158, 475-483. https://doi.org/10.1001/jamasurg.2022.8341
[19]
Itagaki, A., Saitoh, M., Okamura, D., et al. (2019) Factors Related to Physical Functioning Decline after Cardiac Surgery in Older Patients: A Multicenter Retrospective Study. Journal of Cardiology, 74, 279-283. https://doi.org/10.1016/j.jjcc.2019.02.020
[20]
Govers, A.C., Buurman, B.M., Jue, P., de Mol, B.A., Dongelmans, D.A. and de Rooij, S.E. (2014) Functional Decline of Older Patients 1 Year after Cardiothoracic Surgery Followed by Intensive Care Admission: A Prospective Longitudinal Cohort Study.Age and Ageing, 43, 575-580. https://doi.org/10.1093/ageing/afu058
[21]
Inouye, S.K., Peduzzi, P.N., Robison, J.T., Hughes, J.S., Horwitz, R.I. and Concato, J. (1998) Importance of Functional Measures in Predicting Mortality among Older Hospitalized Patients. The Journal of the American Medical Association, 279, 1187-1193. https://doi.org/10.1001/jama.279.15.1187
[22]
Stewart, R.A.H., Szalewska, D., She, L., et al. (2014) Exercise Capacity and Mortality in Patients With Ischemic Left Ventricular Dysfunction Randomized to Coronary Artery Bypass Graft Surgery or Medical Therapy: An Analysis from the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Journal of the American College of Cardiology: Heart Failure, 2, 335-343. https://doi.org/10.1016/j.jchf.2014.02.009
[23]
Ko, H., Ejiofor, J.I., Rydingsward, J.E., Rawn, J.D., Muehlschlegel, J.D. and Christopher, K.B. (2018) Decreased Preoperative Functional Status Is Associated with Increased Mortality Following Coronary Artery Bypass Graft Surgery. PLOS ONE, 13, Article 0207883. https://doi.org/10.1371/journal.pone.0207883
[24]
Robinson, T.N., Eiseman, B., Wallace, J.I., et al. (2009) Redefining Geriatric Preoperative Assessment Using Frailty, Disability and Co-Morbidity. Annals of Surgery, 250, 449-455. https://doi.org/10.1097/SLA.0b013e3181b45598
[25]
Bennett, J.A., Riegel, B., Bittner, V. and Nichols, J. (2002) Validity and Reliability of the NYHA Classes for Measuring Research Outcomes in Patients with Cardiac Disease. Heart Lung, 31, 262-270. https://doi.org/10.1067/mhl.2002.124554
[26]
Barnason, S., Zimmerman, L., Anderson, A., Mohr-Burt, S. and Nieveen, J. (2000) Functional Status Outcomes of Patients with a Coronary Artery Bypass Graft over Time. Heart Lung, 29, 33-46. https://doi.org/10.1016/S0147-9563(00)90035-9
[27]
LaPier, T.K. and Mizner, R. (2009) Outcome Measures in Cardiopulmonary Physical Therapy: Focus on the Late-Life Function and Disability Instrument (LLFDI). Cardiopulmonary Physical Therapy Journal, 20, 32-35. https://doi.org/10.1097/01823246-200920020-00006
[28]
Douki, Z.E., Vaezzadeh, N., Zakizad, M., Shahmohammadi, S., Sadeghi, R. and Mohammadpour, R.A. (2010) Changes in Functional Status and Functional Capacity Following Coronary Artery Bypass Surgery. Pakistan Journal of Biological Sciences, 13, 330-334. https://doi.org/10.3923/pjbs.2010.330.334
[29]
Joskowiak, D., Meusel, D., Kamla, C., Hagl, C. and Juchem, G. (2022) Impact of Preoperative Functional Status on Quality of Life after Cardiac Surgery. The Thoracic and Cardiovascular Surgery, 70, 205-212. https://doi.org/10.1055/s-0039-1696953
[30]
Mori, M., Djulbegovic, M., Hajduk, A.M., Holland, M.L., Krumholz, H.M. and Chaudhry, S.I. (2021) Changes in Functional Status and Health-Related Quality of Life in Older Adults after Surgical, Interventional, or Medical Management of Acute Myocardial Infarction. Seminars in Thoracic and Cardiovascular Surgery, 33, 72-81. https://doi.org/10.1053/j.semtcvs.2020.05.001
[31]
Niemeyer-Guimarães, M., Cendoroglo, M.S., and Almada-Filho, C.M. (2016). Course of Functional Status in Elderly Patients after Coronary Artery Bypass Surgery: 6-Month Follow up. Geriatrics & Gerontology International, 16, 737-746. https://doi.org/10.1111/ggi.12547
[32]
Hunt, J.O., Hendrata, M.V. and Myles, P.S. (2000) Quality of Life 12 Months after Coronary Artery Bypass Graft Surgery. Heart Lung, 269, 401-411. https://doi.org/10.1067/mhl.2000.110578
[33]
Ballan, A. and Lee, G. (2007) A Comparative Study of Patient Perceived Quality of Life Pre and Post Coronary Artery Bypass Graft Surgery. The Australian Journal of Advanced Nursing, 24, 24-28.
[34]
Mori, M., Angraal, S., Chaudhry, S.I., et al. (2019) Characterizing Patient-Centered Postoperative Recovery after Adult Cardiac Surgery: A Systematic Review. Journal of the American Heart Association, 8, e013546. https://doi.org/10.1161/JAHA.119.013546
[35]
Jette, A.M., Haley, S.M., Coster, W.J., et al. (2002). Late Life Function and Disability Instrument: I. Development and Evaluation of the Disability Component. The Journals of Gerontology: Series A, 57, M209-M216. https://doi.org/10.1093/gerona/57.4.M209
[36]
Haley, S.M., Jette, A.M., Coster, W.J., et al. (2002) Late Life Function and Disability Instrument: II. Development and Evaluation of the Function Component. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 57, M217-M222. https://doi.org/10.1093/gerona/57.4.M217
[37]
Jette, A.M., Haley, S.M. and Kooyoomjian, J.T. (2002) Late Life Function and Disability Instrument. MA, Trustees of Boston University.
[38]
Sayers, S.P., Jette, A.M., Haley, S.M., Heeren, T.C., Guralnik, J.M. and Fielding, R.A. (2004) Validation of the Late-Life Function and Disability Instrument. Journal of the American Geriatrics Society, 52, 1554-1559. https://doi.org/10.1111/j.1532-5415.2004.52422.x
[39]
Beauchamp, M.K., Schmidt, C.T., Pedersen, M.M., Bean, J.F. and Jette, A.M. (2014) Psychometric Properties of the Late-Life Function and Disability Instrument: A Systematic Review. BMC Geriatrics, 14, Article No. 12. https://doi.org/10.1186/1471-2318-14-12
[40]
Dubuc, N., Haley, S.M., Ni, P., Kooyoomjian, J.T. and Jette, A.M. (2004) Function and Disability in Late Life: Comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale. Disability and Rehabilitation, 26, 362-370. https://doi.org/10.1080/09638280410001658667
[41]
LaPier, T.K. and Waitt, M. (2007) Using the Late Life Function and Disability Instrument as a Self-Report Outcome Measure in Patients with Cardiovascular Disease. Journal of Cardiopulmonary Rehabilitation and Prevention, 27, 331. https://doi.org/10.1097/01.HCR.0000291340.61795.48
[42]
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. The Journal of the American Medical Association, 310, 2191-2194. https://doi.org/10.1001/jama.2013.281053
[43]
Beauchamp, M.K., Ward, R.E., Jette, A.M. and Bean, J.F. (2019) Meaningful Change Estimates for the Late-Life Function and Disability Instrument in Older Adults. The Journals of Gerontology: Series A, 74, 556-559. https://doi.org/10.1093/gerona/gly230
[44]
Tahir, T., Shah, J.Z., Mukhtar, H., et al. (2023) The Role of Cardiac Rehabilitation in Improving Postoperative Recovery and Long-Term Outcomes after Cardiac Surgery: A Systematic Review. Journal of Population Therapeutics and Clinical Pharmacology, 30, 151-159. https://doi.org/10.53555/jptcp.v30i18.3057
[45]
Gainer, R.A., Curran, J., Buth, K.J., David, J.G., Légaré, J.F. and Hirsch, G.M. (2017) Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives. Medical Decision Making, 37, 600-610. https://doi.org/10.1177/0272989X16675338
[46]
Myles, P.S. (2014) Meaningful Outcome Measures in Cardiac Surgery. The Journal of ExtraCorporeal Technology, 46, 23-27. https://doi.org/10.1051/ject/201446023
[47]
Virani, S.S., Newby, L.K., et al. (2023) 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 148, e186. https://doi.org/10.1161/CIR.0000000000001195
