Long-term quality of life and posttraumatic stress following elective cardiac surgery: preliminary findings of a 5-year follow-up study.

BACKGROUND: Heart surgery is a major stressful event that can have a significant negative effect on patients' quality of life (QoL) and may cause long-term posttraumatic stress reactions. The aim of this pilot study was to estimate the longitudinal change and predictors of health-related quality of life (HRQOL) dynamics and identify factors associated with PTS at 5-year follow-up (T2) after elective cardiac surgery and associations with pre-surgery (T1) QoL. MATERIALS AND METHODS: Single-centre prospective study was conducted after Regional Bioethics Committee approval. Adult consecutive patients undergoing elective cardiac surgery were included. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire before (T1) and 5-years after (T2) cardiac surgery. Posttraumatic stress was assessed using the International Trauma Questionnaire. RESULTS: The pilot study revealed a significant positive change at 5-year follow-up in several domains of SF-36: physical functioning (PF), energy/fatigue (E/F), and social functioning (SF). Prolonged postoperative hospital stay was associated with change in SF (p < 0.01), E/F (p < 0.05) and emotional well-being (p < 0.05). The percentage of patients that had the posttraumatic stress disorder (PTSD) at T2 was 12.2%. Posttraumatic stress symptoms were associated with longer hospitalization after surgery (p < 0.01). CONCLUSIONS: HRQOL improved from baseline to five years postoperatively. Patients with lower preoperative HRQOL scores tended to have a more significant improvement of HRQOL five years after surgery. A prolonged postoperative hospital stay had a negative impact on postoperative social functioning, energy/fatigue, and emotional well-being. Increased levels of PTSD were found in cardiac surgery patients following five years after the surgery.

Impact of pre-operative health-related quality of life on outcomes after heart surgery.

BACKGROUND: Long-term improvement in health-related quality of life (HRQOL) is one of the most important outcomes of cardiac surgery. The aim of this study is to define the impact of perioperative patient and procedural variables on HRQOL dynamics, a year after cardiac surgery. METHODS: Consecutive patients undergoing elective on-pump cardiac surgery were enrolled in this prospective observational cohort study. Patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire a day before surgery and once again a year after surgery. The effect size method was used to determine whether treatment resulted in the improvement of HRQOL. RESULTS: A total of 67.3% of patients achieved long-term improvement in HRQOL. Significant negative association was identified between Physical and Mental Component Summary scores (PCS/MCS) and long-term outcomes. Pre-operative PCS were 40.7 ± 13.7 for improvers and 56.6 ± 14.4 for non-improvers; MCS were 45.8 ± 12.1 and 65.2 ± 13.7, respectively (P < 0.001 for all). There were no statistically significant differences in pre-operative risk factors, demographics, operative factors or post-operative variables between the two groups. CONCLUSION: Among those completing this study, one in three patients did not experience long-term HRQOL improvements following cardiac surgery. Multivariate analysis confirmed that higher pre-operative PCS and MCS are independent predictors of worse HRQOL a year after surgery. Further research should focus on establishing the prevalence of this phenomenon worldwide and develop targeted interventions to improve long-term self-perceived quality of life for patients with relatively good pre-operative health.

Is the Trendelenburg position the only way to better visualize internal jugular veins?

BACKGROUND: A larger cross-sectional area (CSA) of the internal jugular vein (IJV) makes catheterization easier and the Trendelenburg position is used to achieve this. Unfortunately, it is not comfortable for conscious patients. The aim was to evaluate the impact of alternative manoeuvres on the enlargement of the CSA of the IJV and to compare these manoeuvres with the Trendelenburg position. MATERIALS AND METHODS: A prospective study of 63 healthy volunteers was conducted. Two-dimensional ultrasound images of right IJV (RIJV) and left IJV (LIJV) were recorded at the level of the cricoid cartilage in the supine position with and without head rotation by 30 degrees during various manoeuvres. RESULTS: The CSA of the RIJV and the LIJV significantly increased using hold of deep breath (mean size (cm2) RIJV 1.59 ± 0.82, LIJV 1.07 ± 0.64; both p < 0.001) and the Trendelenburg position (mean size (cm2) RIJV 1.5 ± 0.68, LIJV 0.99 ± 0.54; both p < 0.001). The 45-degree passive leg raise increased the CSA of only the RIJV (mean size (cm2) 1.17 ± 0.61, p = 0.024). These manoeuvres were compared with the Trendelenburg position. There was no significant difference in the size of the CSA using hold of deep breath on the LIJV (p = 0.08) and the RIJV (p = 0.203). The passive leg raise had a significantly weaker impact on the size of the CSA (p < 0.001 for both sides). CONCLUSIONS: Hold of deep breath and 45-degree passive leg raise (the latter limited for the right side only) are alternative manoeuvres to improve visualization of internal jugular veins for conscious patients. Hold of deep breath was as effective as the Trendelenburg position.