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Ann Thorac Surg 2003;75:1849-1855
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Patient characteristics can predict improvement in functional health after elective coronary artery bypass grafting

^a Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
^b Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire, USA
^c Section of Cardiothoracic Surgery Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
^d Center for Shared Decision Making, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

Accepted for publication December 23, 2002.

^* Address reprint requests to Dr Welke, Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA.
e-mail: karl-welke{at}uiowa.edu

BACKGROUND: Despite many patients undergoing coronary artery bypass grafting (CABG) to improve their functional status, literature in this area is limited. The purpose of this study is to determine the effect of CABG on the functional health of an elective population and to identify preoperative patient characteristics associated with improved functional health after surgery.

METHODS: Physical and mental functional health was assessed before and 6 months after surgery with the Short-Form Health Survey (SF-36) in 1,061 consecutive patients undergoing elective, isolated CABG. Survey data were complete in 529 patients (49.9%). Preoperative information on patient demographics, severity of cardiovascular illness, and disease comorbidities was also prospectively collected.

RESULTS: Six months post-CABG the mean summary score for physical function improved by 31.9% over baseline (45.1 versus 34.2, p < 0.0001). The mean summary score for mental function improved by 7.3% over baseline (51.3 versus 47.8, p < 0.0001). Overall 73.2% of patients showed improvement in physical function and 41.6% showed improvement in mental function. Multivariate logistic regression identified certain preoperative characteristics as negative correlates of a significant improvement in physical functioning: body mass index 35 kg/m² or greater, diabetes with sequelae, chronic obstructive pulmonary disease, peripheral vascular disease, and baseline physical function. Baseline mental function and chronic obstructive pulmonary disease were identified as negative correlates and older age as a positive correlate of significant improvement in mental functioning.

CONCLUSIONS: Patient characteristics exist that impact functional health after elective CABG. Knowledge of these characteristics may be helpful when counseling patients about expected improvement in functional health with CABG.

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