Gender and Recovery from Coronary Artery Bypass Surgery

About this book

The number of coronary artery bypass graft (CABG) operations has increased continually over the past decade. To date, roughly one-third of these are performed on women. Despite the tremendous progress made in cardiovascular surgery, not all patients profit equally from it, and the mortality rate of women still exceeds that of men by a factor of two. Studies conducted to investigate this marked gender difference have yielded conflicting results. In particular, adjustment for clinical risk factors seemed to diminish the difference, but could not fully explain it.

Therefore psychosocial parameters, in particular depression and psychosocial stress, have gained increasing attention as predictors for both mortality and quality of life after CABG operation. Gender differences in these variables have long been observed in patients undergoing CABG: female patients are on average older, more often depressive and more often living alone than male patients. This book presents the very first German study to focus on these gender differences.

By describing the gender-specific influence of psychological and clinical variables on the recovery process, this work fills an important gap in cardiovascular research. Its approach is interdisciplinary in the best sense. The study underlines the importance of psychosocial variables for both mortality and quality of life in the context of CABG. Thus, it may be seen as a basis for a better understanding and treatment of CABG patients.

Written for: Cardiologists, psychologists

Keywords:

• Bypass surgery
• coronary artery
• gender and recovery

Contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Gender Differences in Mortality after CABG . . . . . . . . . . . . . . . . . . . . . 1
1.2 Gender Aspects of Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2.1 Somatic Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2.2 Psychosocial Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.3 Outcome Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.3.1 Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.3.2 Quality of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.3.3 Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

2 Hypotheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.1 Gender Differences in Risk Factors and Outcomes . . . . . . . . . . . . . . . . . 16
2.2 Moderator Hypotheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.3 Mediator Hypotheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3 Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.1 Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.1.1 Recruitment Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.1.2 Inclusion/Exclusion Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.2 Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.2.1 Outcome Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.2.2 Sociodemographic Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.2.3 Clinical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.2.4 Psychosocial Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.3 General Statistical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.3.1 Missing Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3.3.2 Statistical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3.4 Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.4.1 Sample Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.4.2 Drop-out Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.4.3 Sociodemographic Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

4 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
4.1 Predictors of Mortality and Physical Functioning Based on Preoperative Data . . 30
4.1.1 Description of Predictors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
4.1.2 Predicting Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
4.1.3 Predicting Physical Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4.2 Predictors of Well-Being Based on Longitudinal Data . . . . . . . . . . . . . . 48
4.2.1 Description of Predictors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.2.2 Stress Factors after Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
4.3 Predictive Relationship between Physical Functioning and Depression. 58

5 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
5.1 Gender Differences in Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
5.1.1 Clinical Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.1.2 Sociodemographic Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
5.1.3 Preoperative Depression and Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
5.2 Gender Aspects in Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.2.1 Domestic Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.2.2 Changes in Physical Functioning and Depression . . . . . . . . . . . . . . . . . . 70
5.3 Is Depression Predictive for Physical Functioning? . . . . . . . . . . . . . . . . 72
5.4 Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.5 Clinical Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
5.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

6 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

7 Zusammenfassung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
8.1 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
8.2 Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
8.3 Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98