Introduction
Patients and methods
Patients
Physical activity
2 activity levels | 5 activity levels | Activity description | Activity examples |
---|---|---|---|
Sedentary | Sedentary | Essentially no PA above minimum demands of daily living | Watching TV, working at desk, driving car |
Minimal | Activity during normal daily routine, 15–30 min/day, very light to fairly light exertion | Some stair-climbing, light gardening, light housekeeping, light home repairs | |
Active | Mild | Activity to exercise muscle groups, 15–30 min/day, fairly light to somewhat hard exertion | Calisthenics, lifting weights, heavy gardening, heavy housekeeping |
Moderate | ≥ 1 dynamic activities performed 1–3 times/week, 15 min/session, marked increase in heart rate or somewhat hard exertion | Running, jogging, bicycling, fast walking, dancing, tennis | |
Vigorous | ≥ 1 dynamic activities performed 3 times/week, 20 min/session, somewhat hard to hard exertion | Vigorous calesthenics, aerobic dancing, aerobic workouts, competitive sport | |
Variable | Definition | ||
Pulmonary disease | Long-term use of bronchodilators or steroids for lung disease | ||
Vascular pathology | Claudicatio, carotid occlusion or >50 % stenosis, previous or planned intervention on the abdominal aorta, limb arteries or carotids | ||
Neurological event | History of cerebrovascular accident or transischaemic attack | ||
Redo-surgery | Previous cardiac surgery | ||
Renal insufficiency | Increase of serum creatinine to >200 μmol/L & 2× the baseline creatinine level of a new requirement for dialysis | ||
Insulin | Insulin-dependent diabetes | ||
Myocardial infarction | Preoperative history of a myocardial infarction | ||
Recent myocardial infarction | Myocardial infarction <90 days before surgery | ||
Poor left ventricular function | Left ventricular ejection fraction < 0 % | ||
NYHA IV | New York Heart Association classification IV angina or cardiac insufficiency at rest | ||
BMI | Body mass index (kg/m2) | ||
Reoperation | Operative reintervention for any cause | ||
Stroke | Postoperative history of cerebrovascular accident and/or transischaemic attack | ||
Renal insufficiency | Increase of serum creatinine to >200 μmol/L & 2× the baseline creatinine level of a new requirement for dialysis | ||
Sternal wound problems | A deep sternal infection involves muscle, bone, and/or mediastinum or a sternal refixation without infection |
Outcome variables
Statistical analyses
Results
Patients
Variable | Study population | Excluded group |
p-value |
---|---|---|---|
N = 3150 (%) |
N = 864 (%) | ||
Age (years) | 68.7 ± 10.9 (19–95) | 68.4 ± 10.1 (24–89) | 0.483 |
Female | 847 (27) | 233 (27) | 0.233 |
Additive EuroSCORE | 4.0 ± 2.6 (0–18) | 4.1 ± 2.6 (0–14) | 0.090 |
Logisitic EuroSCORE | 5.06 ± 5.6 (0.88–73.8) | 5.19 ± 5.3 (0.88–38.4) | 0.101 |
Hospital mortality | 22 (0.7) | 7(0.9) | 0.717 |
N = 3150 | ||||
---|---|---|---|---|
Variable | Category | Active N = 1815 | Sedentary N = 1335 |
p-value |
Corpus Christi Heart Project* | 3.50 ± 0.71 (3–5) | 1.75 ± 0.43 (1–2) | 0.001 | |
Age (years) | 68.0 ± 10.0 (19–93) | 69.7 ± 10.0 (19–95) | 0.001 | |
Age group | <65 | 667 (36.7) | 419 (31.4) | 0.001 |
≥ 65–< 75 | 665 (36.6) | 457 (34.2) | ||
≥ 75 | 483 (26.6) | 459 (34.4) | ||
Sex | female | 366 (20.2) | 481 (36.0) | 0.001 |
Additive EuroSCORE | 3.6 ± 2.4 (0–12) | 4.5 ± 2.8 (0–18) | 0.001 | |
Logistic EuroSCORE | 4.4 ± 4.7 (0.8–51.2) | 5.9 ± 6.6 (0.88–73.8) | 0.001 | |
Risk group | Low | 657 (36.2) | 351 (26.3) | 0.001 |
Medium | 744 (41.0) | 494 (37.0) | ||
High | 414 (22.8) | 490 (36.7) | ||
Pulmonary disease | Yes | 150 (8.3) | 183 (13.7) | 0.001 |
Vascular pathology | Yes | 206 (11.3) | 276 (20.7) | 0.001 |
Redo-surgery | Yes | 66 (3.6) | 65 (4.9) | 0.087 |
Renal disease | Yes | 10 (0.6) | 29 (2.2) | 0.001 |
Neurological event | Yes | 164 (9.0) | 167 (12.5) | 0.002 |
Insulin | Yes | 123 (6.8) | 146 (10.9) | 0.001 |
Myocardial infarction | Yes | 520 (28.7) | 410 (30.7) | 0.210 |
Recent myocardial infarction | Yes | 153 (8.4) | 85 (6.4) | 0.030 |
Poor left ventricular function | Yes | 59 (3.3) | 64 (4.8) | 0.027 |
NYHA IV | Yes | 94 (5.2) | 91 (6.8) | 0.055 |
BMI | 27.12 ± 3.8 (16.6–53.8) | 28.23 ±4.6 (13.4–48.3) | 0.001 | |
BMI >30 | Yes | 356 (19.6) | 429 (32.1) | 0.001 |
Type of surgery | Valve | 553 (30.5) | 444 (33.3) | 0.096 |
N = 3150 | ||||
---|---|---|---|---|
Variable | Active N = 1815 | Sedentary N = 1335 |
P-value | |
Hospital mortality | Yes | 7 (0.4) | 15 (1.1) | 0.014 |
Reoperation | Yes | 105 (5.8) | 68 (5.1) | 0.400 |
Stroke | Yes | 9 (0.5) | 12 (0.9) | 0.170 |
Renal insufficiency | Yes | 32 (1.8) | 39 (2.9) | 0.030 |
Sternal wound problems | Yes | 10 (0.6) | 17 (1.3) | 0.030 |
Ventilation >2 days | Yes | 31 (1.7) | 54 (4.0) | 0.001 |
Intensive care stay (days) | Yes | 1.3 ± 1.9 (0–53) | 3.0 ± 41.8 (0–194) | 0.001 |
Intensive care stay > 5 days | Yes | 19 (1.0) | 46 (3.4) | 0.001 |
Variable | Hospital mortality | Early mortality | ||
---|---|---|---|---|
Variables entered in the regression model |
p-value | OR (95%CI) |
p-value | OR (95%CI) |
Old age ≥75 years | 0.33 | 1.6 (0.5–4.5) | 0.17 | 1.8 (0.7–4.6) |
Valve surgery | 0.12 | 2.6 (0.7–9.2) | 0.052 | 2.7 (0.9–7.6) |
Female gender | 0.051 | 0.3 (0.1–1.0) | 0.047 | 0.4 (0.1–0.9) |
High risk | 0.052 | 5.6 (0.9–32.2) | 0.14 | 2.6 (0.7–9.6) |
Renal disease | 0.027 | 6.7 (1.2–36.6) | 0.008 | 6.9 (1.9–29.1) |
BMI >30 | 0.118 | 0.3 (0.1–1.2) | 0.359 | 0.6 (0.2–1.6) |
NYHA IV | 0.001 | 7.7 (2.7–22.3) | 0.001 | 5.7 (2.2–14.5) |
Insulin use | 0.054 | 3.2 (0.9–10.6) | 0.051 | 2.6 (0.9–7.2) |
Vascular pathology | 0.865 | 0.9 (0.2–2.9) | 0.70 | 0.8 (0.2–2.2) |
Recent myocardial infarction | 0.658 | 1.5 (0.2–11.2) | 0.76 | 0.7 (0.1–4.3) |
Poor left ventricular function | 0.058 | 3.4 (0.9–12.7) | 0.035 | 3.3 (1.1–10.2) |
Lung disease | 0.001 | 4.9 (1.8–13.0) | 0.005 | 3.4 (1.4–8.1) |
Myocardial infarction | 0.797 | 0.9 (0.2–3.3) | 0.32 | 1.6 (0.6–4.4) |
Sedentary lifestyle | 0.617 | 1.2 (0.4–3.5) | 0.70 | 1.1 (0.5–2.7) |
Neurological event | 0.896 | 0.9 (0.2–3.6) | 0.70 | 1.5 (0.5–4.6) |
Performance | ||||
Hosmer-Lemeshow χ
2* (without sedentary lifestyle) | 12.5 (0.126) | 5.9 (0.656) | ||
Hosmer-Lemeshow χ
2* (with sedentary lifestyle) | 9.9 (0.267) | 4.4 (0.881) |