Beneficial effects of weight loss with a high protein diet on body composition, functional status, lipid profiles, and quality of life in overweight and obese heart failure patients: a feasibility study (2008)

Journal of Cardiovascular Nursing Vol. 24, No. 3, pp 198Y206 x Copyright B 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Coronary Artery Bypass Graft Surgery Exploring a Broader Perspective of Risks and Outcomes Jo-Ann V. Sawatzky, PhD, RN; Barbara J. Naimark, PhD, RN Although the literature is replete with evidence related to physiological predictors and short-term outcomes of coronary artery bypass graft (CABG) surgery, there is still a paucity of data that encompass a broader perspective of risk and outcomes. The primary objective of this prospective cohort study was to explore the physiological and psychosocial dimensions of preoperative status that may be predictive of the short- and longer term outcomes of CABG surgery. Patients (N = 136) scheduled for elective/urgent CABG surgery were followed from the time of placement on the waiting list until 6 months after the surgery. Significant predictors of intensive care unit length of stay (LOS) included the following: age, urgency of operation, and perioperative complications. Hospital LOS was best predicted by baseline unemployment, longer bypass time, and perioperative complications. Baseline unemployment and less optimism regarding surgery outcomes were predictive of postdischarge home care utilization. Lower baseline physical functioning predicted postdischarge emergency room visits. Sex and baseline mental status predicted quality of life/health satisfaction scores at 6 weeks and 6 months after discharge. The ability to predict patient outcomes has implications for program planning, patient education, and policy development. The findings of this study provide rationale for clinicians, educators, and administrators to consider a broader scope of physiological and psychosocial parameters to predict outcomes of CABG surgery. Although the sample size was relatively small, the broader perspective on risk and outcomes provides insight for strategies to optimize overall outcomes for the CABG surgery population. These findings also establish the cornerstone for ongoing CABG surgery outcomes evaluation and research. KEY WORDS: cardiac surgery, coronary artery bypass graft, outcomes, quality of life Introduction/Background Cardiovascular disease (CVD) is the leading cause of mortality in Canada, accounting for approxi- mately one-third of all deaths each year. 1 For the first 3 decades after its inception, the demand for coronary artery bypass graft (CABG) surgery grew exponentially; this demand still continues to increase at a modest rate. 2,3 Advances in surgical technology and expanding accessibility, combined with the increasing burden of coronary heart disease (CHD) and aging of the population, suggest that this escalating trend will continue in the years to come. Jo-Ann V. Sawatzky, PhD, RN Associate Professor, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada. Barbara J. Naimark, PhD, RN Associate Professor, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada. Corresponding author Jo-Ann V. Sawatzky, PhD, RN, 367 Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, Manitoba, Canada R3T 2N2 (joanne_sawatzky@umanitoba.ca). Although CABG surgery is an established treatment for CHD, it is a costly, invasive procedure, which carries a discernible risk for adverse outcomes. The research literature is replete with evidence related to the factors that increase the risk of cardiac surgery, but most of that evidence focuses on the physiological predictors of CABG surgery outcomes, such as the severity of the disease (eg, the number and percentage of coronary artery occlusions and ejection fractions) and comorbidities (eg, diabetes and chronic obstructive pulmonary disease). There is also considerable evidence regarding the significance of demographic factors such as age and sex; also, several studies have addressed the broader socio- economic health determinants, including income, edu- cation, employment status, and social support. In addition, there is an emerging evidence on the sig- nificance of one’s general health status (ie, quality of life [QOL]) as a predictor of postoperative outcomes. However, there is a paucity of data that encompass the broader perspective of risk and outcomes. The purpose of this study was to explore the rela- tionship between the physiological and psychosocial Copyright @ 200 9 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.