Psychosocial issues facilitating recovery post-CABG surgery

doi:10.1016/S1036-7314(05)80006-2

Australian Critical Care

Volume 18, Issue 2, April 2005, Pages 76-85

https://doi.org/10.1016/S1036-7314(05)80006-2 Get rights and content

Background

The acute illness phase following coronary artery bypass graft (CABG) surgery is a difficult time for patients as they try to adjust to the physical and emotional changes brought about by surgery.

Aims

To conduct an indepth examination of psychosocial issues experienced by patients post-CABG surgery and how patients manage these psychosocial issues during their recovery.

Methods

A qualitative research approach, naturalistic inquiry, guided the study. Thirty patients were interviewed 4–5 weeks following discharge from hospital after CABG surgery and at 12 months after the initial interview.

Results

Results found that adjusting to life after surgery was difficult, and patients experienced some form of physical pain or change. An unexpected finding was the extent to which many of the patients were attuned to their post-operative physical adjustments. Patients spoke of mental and emotional changes, and coming to terms with lifestyle adjustments.

Conclusion

Study findings suggest the need for a re-examination of hospital discharge preparation and further provision and monitoring of home support services.

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Cited by (10)

Association of poor sleep quality with risk factors after coronary artery bypass graft surgery—A prospective cohort study
2020, Journal of Vascular Nursing
Citation Excerpt :
In terms of sleep onset (sleep latency), the time taken to fall asleep among 30.5% of patients was within 30 minutes, 67.34% of patients had experienced daytime dysfunction, and 64% experienced sleep disturbance. These sleep patterns with patient recovery were consistent with the findings from other studies.14,35,36 This is possible because of the inter-relationship between sedentary lifestyle, anxiety, comorbidity, obesity, and sleep quality.
Fragmented sleep is a daunting experience and a common health problem with high prevalence among patients 3 months after coronary artery bypass grafting (CABG). However, the potential predictors on poor seep quality remains unexplored. The main purpose of this study was to determine the predictors of poor sleep quality among patients 3 months after CABG. A prospective cohort study is a part of the randomized controlled trial between 2012 and 2013 in which 400 adult patients undergoing elective CABG were being randomly sampled as per the inclusion criteria followed up at 3 months after CABG surgery in the cardiovascular outpatient clinic of a tertiary-care hospital. The study was conducted according to the Declaration of Helsinki and was approved by the institutional ethical committee. All participants gave written informed consent on having received detailed information on the study. Demographic and clinical data were obtained from medical records at the time of CABG. The data on sleep quality were collected by using the Pittsburgh Sleep Quality Index and state anxiety was evaluated utilizing state-trait anxiety inventory (STAI-YI fo3rm). Multivariable logistic regression examined the association between the postoperative poor sleep quality and clinical, preoperative state anxiety, and angina. The significant variables are chosen based on the P-value associated with the significant level of model that lies on α = 0.05. Logit determination and the correlation between the variables are also discussed for further analysis. A total of 187 patients (mean age 55.6 ± 12.05 years) completed the questionnaire. Most patients (78%) reported poor sleep quality (4.23 ± 1.24) (PQSI score of less than 5). There was a strong relationship between PQSI and state anxiety. The higher state anxiety among 68% of patients with the mean score (53.51 ± 9.55) had 6.42 (95% CI 3.04–9.61) times the odds of being classified as high risk for sleep disturbance. There are 3 factors that most significant of the 8 factors tested were identified as having influence significantly on the poor sleep quality. These factors are diabetes (OR 1.186, 95% CI 1.016–1.097, P > .01), body mass index > 30 kg/m² (OR 2.36, 95% CI 1.041–1.172, P > .05), sedentary lifestyle (OR 1.091, 95% CI 1.016–1.159, P > .01), and preoperative state anxiety (OR 1.186, 95% CI 1.074–1.115, P > .01). Even though the body mass index>30 kg/m², sedentary lifestyle, and diabetes were significantly associated with sleep quality, the only factor with more significantly related to poor sleep quality was preoperative state anxiety which is the strong predictor of poor sleep quality. Hence, early recognition of predictors and careful management of poor sleep quality is warranted.
Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: An age and sex propensity matched study
2015, Australian Critical Care
Citation Excerpt :
A prognostic association between psychological depression and postoperative morbidity after coronary artery bypass graft (CABG) surgery has been previously documented.1–5
The cardiovascular risk profile and postoperative morbidity outcomes of anxiety disorder patients undergoing coronary artery bypass surgery is not known.
In a cross-sectional design, 114 consecutive coronary artery bypass graft surgery patients were evaluated to create four matched groups (30 with anxiety disorder, 27 with depression disorder and 57 age-sex matched coronary artery bypass surgery control patients with no depression or anxiety disorder).
By comparison to non-depression disorder age-sex matched controls, depressed patients presented for coronary artery bypass surgery with significantly greater myocardial inflammatory markers (Troponin T > 02, 33.3% vs. 11.1%, p = .03), metabolic risk (body surface area > 35 (22.2% vs. 0%, p = .03), comorbid cardiovascular risk (peripheral vascular disease 18.5% vs. 0%, p = .05). Depressed patients also recorded longer intraoperative time at higher temperatures >37 °C on cardiopulmonary bypass (11.1 ± 9.0 vs. 6.0 ± 4.9, p < 005) and had higher maximum postoperative Troponin T (.44 ± .2 vs. .28 ± .1, p = .03). Patients with anxiety disorder on the other hand presented with significantly higher Creatinine Kinase-Muscle Brain (5 IQR 4–5 ng/ml vs. 4 IQR 3–4 ng/ml, p = .04), higher intraoperative glucose levels (7.8 ± 2.5 mmol/l vs. 7.0 ± 1.2 mmol/l, p = .05), and received fewer grafts (2.1 ± .9 vs. 2.5 ± .9 p = .04).
A differential cardiovascular risk profile and postoperative outcome was observed dependent on anxiety and depression disorder status. There were few modifiable cardiovascular risk factors at the time of surgery other than psychiatric status, perioperative management of depression and anxiety may have promise to reduce further cardiac morbidity after coronary artery bypass surgery.
Physical, psychological and social recovery patterns after coronary artery bypass graft surgery: A prospective repeated measures questionnaire survey
2007, International Journal of Nursing Studies
This study examined the physical, psychological and social recovery patterns of Hong Kong Chinese patients who have undergone CABG surgery over a period of six months.
Recovery from coronary artery bypass graft (CABG) surgery is a dynamic process and the associated physical, psychological and social effects could lead to failure to recuperate leading to hospital re-admission and morbidity.
A prospective repeated measures design was used for this research. Patients were interviewed in person 5 days before surgery and at 1 week after discharge, and by telephone at 3 and 6 months after discharge. Physical recovery dimension was assessed by three categories of the Sickness Impact Profile (ambulation, sleep-rest, body movement and care). Social recovery dimension was assessed by three categories of the Sickness Impact Profile (SIP) (home management, social interaction, and recreation and pastimes). Psychological recovery was assessed using the Centre for Epidemiologic Studies—Depression (CES-D).
Sixty-eight patients participated in this research. The mean physical SIP-dimension score and depression level at discharge was the highest then gradually decreased at 6 months after CABG. The SIP-physical and SIP-social and depression level differed significantly across the four-assessment time within-group. There were no gender differences in physical and social recovery and depression levels. Patients who had poorer physical and social recovery had more depression at one week and three months after CABG surgery.
Patients should be prepared for discharge after CABG surgery. Cultural factors may have influenced the similar recovery patterns between genders. These factors contributing to early recovery must be further examined.
Because of the large number of patients who undergo CABG worldwide, and because of healthcare cost related to this intervention, it is important for both patients and healthcare providers to have realistic expectations about the recovery process and to recognise deviations from the norm. The results provided some insights into the Hong Kong Chinese patients’ recovery from CABG surgery that would guide the development of culturally appropriate pre-operative and discharge teaching for this group of patients.
Occupational therapy and participation in activities of daily living following cardiothoracic surgery in acute care: A retrospective study
2023, British Journal of Occupational Therapy
Health-related personal control predicts depression symptoms and quality of life but not health behaviour following coronary artery bypass graft surgery
2016, Journal of Behavioral Medicine
Sleep quality and emotional correlates in Taiwanese coronary artery bypass graft patients 1 week and 1 month after hospital discharge: A repeated descriptive correlational study
2015, PLoS ONE

View all citing articles on Scopus

View full text

Psychosocial issues facilitating recovery post-CABG surgery

Background

Aims

Methods

Results

Conclusion

Applied Nursing Research

Nursing Clinics of North America

Journal of Psychosomatic Research

Journal of Psychosomatic Research

General Hospital Psychiatry

Journal of Psychosomatic Research

Journal of Psychosomatic Research

Heart and Lung

International Journal of Nursing Studies

Applied Nursing Research

Clinical Investigations

Social Science & Medicine

Social Science & Medicine

International Journal of Nursing Studies

Heart, stroke and vascular diseases

Unending work and care

Women recovering from coronary artery bypass surgery

Scholarly Inquiry for Nursing Practice

Preparing patients for early discharge after CABG

American Journal of Nursing

Depressive symptomatology in coronary artery bypass graft surgery patients

International Journal of Geriatric Psychiatry

The delirious cardiac surgical patient: theoretical aspects and principles of management

Journal Cardiovascular Nursing

Prospective evaluation of verbal memory performance after cardiopulmonary bypass surgery

Journal of Clinical and Experimental Neuropsychology

Quality of life during rehabilitation after coronary artery bypass surgery

Quality of Life Research

What does the literature report about post-discharge telephone interventions by nurses for coronary artery bypass graft surgery patients and their partners?

Canadian Journal of Cardiovascular Nursing

Coronary artery bypass surgery: physical, psychological, social and economic outcomes six months later

JAMA

Measurement of coping strategies, concerns, and emotional responses in patients undergoing coronary artery bypass grafting

Heart and Lung

Gender differences in distress and depression following cardiac surgery

Journal of Gender, Culture, and Health

Perception of cognitive function in older adults following coronary artery bypass surgery

Health Psychology

The incidence and nature of neuropsychological morbidity following cardiac surgery

Perfusion

Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery

The New England Journal of Medicine