Preoperative disabilty and its relationship with morbidity after cardiac surgery
Authors: Wleklik M , Lisiak M , Hydzik P , Uchmanowicz I 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Disability is defined as functional problems in performing activities of daily living necessary for independent living and reflects the interaction between the individual and the surrounding environment. Disability may affect up to 76% of patients qualified for cardiac surgery. Disabilty as a construct that increases the perioperative risk may contribute to the loss of autonomy, increase dependence on others and reduce the quality of life. In addition, it is associated with longer hospital stays, increased use of healthcare resources, institutionalization and mortality.

Purpose
Assessment of the relationship between preoperatively assessed disabilty and postoperative morbidity in cardiac surgery patients.

Material and Methods
The study included 100 patients (60 men, 40 women, mean age 71.69 ± 4.96) scheduled for elective cardiac surgery. The study used a self-designed questionnaire to collect sociodemographic data, an analysis of medical records to collect data on postoperative morbidity, and a standardized tool for disability assessment. In the assessment of disability, the Nagi scale (assessment of difficulty in performing activities such as: pulling or pushing a chair, bending, crouching or kneeling, raising hands above the head, lifting or carrying small objects in the fingers, lifting 5 kg, going up or down stairs, walking 1.5 kg) was used, where significant disability is diagnosed when ≥ 3 points are obtained. The assumed significance level was p &lt; 0.05.

Results
In the Nagi scale, the study group obtained an average score of M±SD = 3.41±1.83 points before the procedure. Women scored significantly higher on the Nagi scale than men (M±SD = 3.981. ±76 vs. MS±D = 3.03±1.79, p = 0.008). Patients with prolonged respiratory therapy had a significantly higher Nagi score before the procedure than patients without this complication (M±SD = 4.31±1.75 vs. M±SD = 3.04±1.74, p = 0.003). Patients who required hospitalization for more than 14 days before the procedure had a significantly higher score on the Nagi scale than patients without this complication (M±SD = 5.40±1.67 vs. M±SD = 3.31 ±1.79, p = 0.022). Patients with the composite morbidity endpoint had significantly higher Nagi scores before surgery (MS±D = 3.77±1.87 vs. M±SD = 2.88±1.65, p = 0.013). In univariate analysis, the Nagi score (OR: 1.32, 95% CI: 1.04-1.68, p = 0.019) and the Nagi score ≥3 points (OR: 2.96, 95% CI: 1.20-7.28, p = 0.017) were significant predictors of postoperative morbidity. The value of the Nagi scale as a continuous variable (OR: 1.29, 95% CI: 1.02-1.64, p = 0.033) and Nagi ≥3 points (OR: 2.71, 95% CI: 0.48-6.61, p = 0.032) were age- and multimorbidity-independent predictors of postoperative morbidity in the study group.
Coclusions. Disabilty identified before the procedure has a negative impact on the incidence of postoperative morbidity in cardiac surgery patients. Assessment of disability before cardiac surgery is important in predicting outcomes.