Hawkes et al Social functioning The emphasis on treating patients as social beings who live in a complex social context has permeated many branches of medicine. This approach holds that the ultimate aim of medical care should be to reintegrate the individual into a normal, productive life in society, rather than merely to treat their medical symptoms (McDowell and Newell 1996). Many studies have highlighted the importance of social support in attenuating the effects of stressful events and thereby reducing the incidence of disease, although there is substantial variability in the manner in which social support has been conceptualized and measured (Orth-Gomer et al 1998; Lett et al 2005). Social support is generally defined in terms of the availability of trusted, reliable people who make the individual feel cared for and valued. The emphasis in related sociomedical indices lies with assessing the quality, rather than the number or type, of relationships (McDowell and Newell 1996; Lett et al 2005). Some studies of social functioning following CABG have shown little change in social activities (CASS PI 1983; Jenkins et al 1983), while others have reported an increase in social interaction (Mayou and Bryant 1987; Ross and Ostrow 2001). An investigation of social interactions of CABG patients found a stable level of interaction for 48% of patients, an increase for 28%, and a decrease for 24% of patients 6 months after surgery (Jenkins et al 1983). Another study reported a general increase in leisure activities, social activities, and satisfaction post-surgery (Mayou and Bryant 1987). However, only a minority of patients appear to take advantage of angina relief post-surgery by undertaking more energetic pastimes. Thus, it seems that CABG patients are able to perform their usual undemanding activities more comfortably following surgery, but may have little desire to dramatically change the pattern of their lives (Mayou and Bryant 1987; Pollick 1993). Vocational status An important goal of CABG is the resumption of gainful employment in employment-eligible patients (Allen 1990). In a review of 15 studies, 80% of patients were less likely to be employed after CABG, while for 20% there was no change or an improvement. The percentage of patients employed after CABG ranged from 38% to 81% (average 62%) (Allen 1990). In the CASS study, a consistent annual decline in employment was observed, with 76% employed at baseline and 52% at 5 years (CASS PI 1983). A more recent study found that employment rates pre-surgery, 6 and 12 months 482 post-surgery were 36%, 34%, and 21% respectively, although these results were not controlled for age (Skinner et al 1999). Patients may also experience a decline in income post-surgery as a result of employment changes (Jenkins et al 1983). Some variables consistently appear to predict employment after CABG, although investigators have used different CABG populations, employment definitions, end points, and follow- up times. There have also been methodological limitations. The major predictor of post-operative employment is pre- operative work status, which accounts for more than 40% of the total variance in post-operative employment (Hlatky et al 1998; Geissler and Aggestrup 2002). Patients who expect to return to work post-surgery are also more likely to do so (Allen 1990; Skinner et al 1999). Predictors of failure to return to work have included: older age; more severe CHD; more chronic medical conditions; persistent angina; female gender; co-morbidities; pre-operative fatigue; blue-collar workers; higher income; and negative communications from physicians and family regarding return to work (Allen 1990; Mittag and Schwarzer 1993; Hlatky et al 1998; Skinner et al 1999). Other variables influencing return to work are: prolonged waiting time for surgery; the economic environment; the availability of disability payments; and the increasing age of the population (Skinner et al 1999). Conclusion Coronary artery bypass surgery remains an established form of treatment for coronary artery disease, and the majority of coronary surgical procedures are performed for multiple vessel disease. Overall, the mortality rate of coronary artery surgery is low, at around 2%–3% (Keogh and Kinsman 2004), although this benefit is offset by a complication rate of 20%–30%. Furthermore, post-surgical neurocognitive impairment is of concern (Wolman et al 1999; Newman et al 2001). PCI has had a dramatic effect on CABG, arresting the dramatic growth of surgery in the 1980s and shifting the attention of surgeons to patients with more advanced coronary disease and extensive coexisting conditions. This has motivated surgeons to refine coronary revascularization techniques in order to maximize clinical effectiveness, limit costs, and reduce invasiveness. Outcomes of CABG have historically been measured in terms of mortality and morbidity; however adjustment to CABG is a multidimensional phenomenon that is not fully explained by medical factors. When investigating post- operative adjustment to CABG, it is important to assess various physical, psychological and social variables as well, which is increasingly being recognized in recent studies. Vascular Health and Risk Management 2006:2(4)