Weight and patients' decision to undergo cardiac surgery.

Obese patients are less likely to have cardiac surgery than normal weight patients. This could be due to physician or patient decision-making. We undertook a qualitative descriptive study to explore the influence of obesity on patients' decision-making to have cardiac surgery. Forty-seven people referred for coronary artery bypass graft (CABG) surgery were theoretically sampled. Twelve people had declined cardiac surgery. Participants underwent in-depth interviews aimed at exploring their decision-making process. Data were analyzed using conventional content analysis. Though patients' weight did not play a role in their decision, their relationship with their cardiologist/surgeon, the rapidity and orchestration of the diagnosis and treatment, appraisal of risks and benefits, previous experience with other illness or others who had cardiac surgery, and openness to other alternatives had an impact. It is possible that there is a lack of comfort or acknowledgment by all parties in discussing the influence of weight on CABG surgery risks.

Adhesive-enhanced sternal closure to improve postoperative functional recovery: a pilot, randomized controlled trial.

BACKGROUND: We previously established a proof-of-concept in a human cadaveric model where conventional wire cerclage was augmented with a novel biocompatible bone adhesive that increased mechanical strength and early bone stability. We report the results of a single-center, pilot, randomized clinical trial of the effects of adhesive-enhanced closure of the sternum on functional postoperative recovery. METHODS: In 55 patients undergoing primary sternotomy, 26 patients underwent conventional wire closure and were compared with 29 patients who underwent adhesive-enhanced closure, which consisted of Kryptonite biocompatible adhesive (Doctors Research Group Inc, Southbury, CT) applied to each sternal edge in addition to conventional 7-wire cerclage. Patients were monitored postoperatively at 72 hours, weekly for 12 weeks, and then after 12 months for incisional pain, analgesic use, and maximal inspiratory capacity measured by spirometry. Standardized assessment tools measured postoperative physical disability and health-related quality of life. RESULTS: No adverse events or sternal complications from the adhesive were observed early or after 12 months. Incisional pain and narcotic analgesic use were reduced in adhesive-enhanced closure patients. Inspiratory capacity was significantly improved, postoperative health-related quality of life scores normalized more rapidly, and physical disability scores were reduced. Computed tomography imaging was suggestive of sternal healing. CONCLUSIONS: Adhesive-enhanced closure is a safe and simple addition to conventional wire closure, with demonstrated benefits on functional recovery, respiratory capacity, incisional pain, and analgesic requirements. A large, multicenter, randomized controlled trial to examine the potential of the adhesive to prevent major sternal complications in higher risk patients is warranted.

The influence of coronary artery bypass graft harvest site on women's pain, functional status, and health services utilization throughout the first post-operative year: a longitudinal study.

BACKGROUND: Coronary artery bypass graft surgery is a commonly performed procedure aimed at managing coronary symptoms and prolonging life. Researchers have typically examined morbidity and mortality outcomes of predominantly male populations. Less is known about the influence of graft harvest site on recovery outcomes such as surgery-related pain, functional status, and health services utilization, especially in women. OBJECTIVES: We aimed to examine the relationships between coronary artery bypass graft harvest site (saphenous vein, internal mammary arteries or both) and surgery-related pain, functional status, health services use at 6 weeks, 12 weeks and 12 months post-operatively. DESIGN: Longitudinal extension survey following participation in a clinical trial. SETTING: Ten Canadian centres. PARTICIPANTS: Women (222) who participated in the Women's Recovery from Sternotomy Trial, underwent coronary artery bypass graft surgery with or without heart valve surgery, and completed the 12-month follow-up interview. METHODS: Harvest site data were collected by health record audit at the time of hospital discharge. Surgery-related pain, functional status, pain medication use and health services use data were collected by standardized interview over the telephone at 6 weeks, 12 weeks and 12 months post-operatively. Surgery-related pain and functional status were measured using the short Health Assessment Questionnaire. Health services use was measured by questionnaire and recorded as reported by the participants. RESULTS: Surgery-related pain, functional disability and health services use decreased over the first post-operative year. Participants who had left internal mammary artery grafts were more likely to have surgery-related pain (Adjusted Odds Ratio (AOR)=2.79; 95% Confidence Interval (CI) 1.40-5.70) and use pain medication (AOR=4.32; 95% CI 1.44-12.91) than those who had saphenous vein grafts. Conversely, participants who had saphenous vein grafts reported significantly more functional disability (AOR=2.63; 95% CI 1.16-6.25) over 12 months post-surgery than those with left internal mammary artery grafts. Participants who had pain over the course of follow-up were more likely to visit their family physician or nurse practitioner (p=0.017), visit another type of provider (i.e., naturopath or chiropractor, p=0.004), or use any health care service (p<0.0001). CONCLUSIONS: Following coronary artery bypass graft surgery, women who had left internal mammary artery grafts reported more pain and health services use while those who had saphenous vein grafts were more functionally disabled. Women who reported surgery-related pain also used more health services.

A descriptive examination of the impact of sternal scar formation in women.

Formation of abnormal scars is a significant source of morbidity following sternotomy. We undertook a descriptive exploratory mixed methods study of women (n=13) who participated in the Women's Recovery from Sternotomy Trial to examine the: (1) qualitative impact of the cosmetic result of sternotomy, and (2) quantitative association between subjective satisfaction and objective ratings of the sternal scar. Conventional content analysis was used to analyze the data generated from semi-structured interviews. Though the participants appreciated that having the scar was a cost of reaping the benefits of having cardiac surgery, they were not well prepared to learn to live with the scar. The scar was a poignant personal reminder that they had a health problem and underwent a distressing surgery, and it often rendered them feeling less attractive. The scar also had a public presence that they perceived rendered judgment from others. There was little association between the participants' subjective satisfaction (rated on a likert-type scale) and the objective scar rating using the Beausang Clinical Scar Assessment (r=0.348, p=0.294). The subjective perception of the sternal scar is of importance to women. Thus, appropriate preparation, post-operative counseling and support regarding the sternal scar are warranted.