Impact of Preoperative Functional Status on the Health-Related Quality of Life after Cardiac Surgery—A Prospective Study

Objectives: Clinical outcomes after cardiac surgery cannot readily be used as the sole quality criterion for the outcome of the surgical procedure. The health-related quality of life (QoL) of patients (pts) in this context represents an important issue. The validity of many studies in this regard is very limited, as preoperative QoL data are often lacking. The aim of our study is to evaluate the change in QoL 3 and 12 months after cardiac surgery compared with preoperative data.

Methods: Consecutive 165 pts undergoing elective cardiac surgery were enrolled in this prospective study. Pts completed the SF-36 Survey questionnaire a day before and once again 3 and 12 months after surgery. The minimal clinically important difference was used to determine whether the surgical treatment resulted in improvement of QoL.

Results: Preoperative and postoperative SF-36 questionnaires were completed by all pts. In general, we observed a significant improvement in mean physical and mental component summary (PCS/MCS) at 3 and 12 months after surgery (PCS: 40.5 ± 11.0 vs. 44.6 ± 9.3 vs. 50.0 ± 9.0, p < 0.001; MCS: 46.7 ± 10.8 vs. 47.7 ± 11.7 vs. 49.1 ± 11.8, p = 0.012, respectively). However, some patients also experienced deterioration in QoL. This effect was most pronounced 3 months after surgery (worsening of PCS and MCS compared with baseline in 19.3 and 29.5% of pts, respectively). In the further course, these pts recovered so that after 12 months, only 9.0% showed a worse PCS and 19.3% a worse MCS. Multivariate logistic regression analysis revealed higher SF-36 baseline values and age (< 69 years) as independent predictors for deterioration of both PCS (odds ratio [OR]: 1.08, confidence interval [CI]: 1.02–1.15, p = 0.016 and OR: 6.24, CI: 1.22–31.84, p = 0.028, respectively) and MCS (OR: 1.07, CI: 1.03–1.12, p = 0.002 and OR: 2.40, CI: 1.06–5.45, p = 0.037, respectively). Preexisting neurological disorder (OR: 10.65, CI: 2.04–55.53, p = 0.005) and coronary artery bypass grafting (OR: 3.02, CI: 1.30–7.00, p = 0.010) were identified as further independent predictors of PCS and MCS deterioration, respectively.

Conclusion: In our study, we were able to demonstrate a general improvement in QoL after cardiac surgery, even though the pts recovered at different time intervals postoperatively. Up to one-third of pts have a worse QoL 3 months postoperatively than preoperative and one in five pts did not experience long-term QoL improvements a year after surgery. This effect is mainly driven by the preoperative functional status.