[Myocardial revascularization surgery: short and long-term survival analysis].

BACKGROUND: This study sets out to describe the survival and clinical evolution of patients who undergo myocardial re-vascularisation surgery, and identifies the short- and long-term predictive factors for surgical outcomes. METHODS: Study of a cohort of 175 patients undergoing pure or mixed coronary myocardial revascularisation surgery at a heart surgery unit, recruited between 2008 and 2010 and monitored for ten years. Descriptive and logistic regression (OR and 95%CI) analysis were carried out, along with an analysis of survival by Kaplan Meier and Cox uni- and multivariate regression (HR and 95%CI) in the short- (one year) and long-term (ten years). RESULTS: Predominantly male cohort (85.1%), mean age of 67 years (45-84), and mean EuroSCORE of 5.3%. Mortality was 6.8 and 26.9% at 1 and 10 years, respectively. Mean survival of deceased individuals was 40 months (32.2-47.8). In the short-term, a better NYHA =III preoperative functional level was not significantly associated with lower mortality (OR: 0.11; 95%CI: 0.01-1.08; p=0.058), while being female (OR: 2.94; 95%CI: 1.01-8.57; p=0.048) and having a EuroSCORE of >4% (OR: 4.94; 95%CI: 1.52-16.10; p=0.008) showed an increased risk of presenting adverse cardiac events. In the long-term, greater age (HR: 1.06; 95%CI: 1.01-1.10; p=0.026) and lower rates of body mass index after the first postoperative year (HR: 0.90; 95%CI: 0.81-0.99; p=0.040) were independent predictors of mortality. CONCLUSION: Age was an independent predictor of long-term mortality, while being female and a EuroSCORE >4% were associated with a higher risk of suffering from short-term cardiovascular events.

[Health-related quality of life two years after myocardial revascularization surgery].

BACKGROUND: To describe the levels of health-related quality of life (HRQoL) attained and the magnitude of the effect of myocardial revascularization surgery. METHOD: Prospective descriptive study that, using the SF-12v2 health questionnaire and different socio-demographic and clinical variables, evaluated during a two-year follow-up the HRQoL of patients who had received myocardial revascularization surgery in the Cardiac Surgery service. RESULTS: One hundred and seventy-five patients were included with an average age of 67 years (range 45-84), 85.1% men. Seventy-two point five percent received complete revascularization surgery and 80.8% received a multiple bypass; the average EuroSCORE was 5.3%. The preoperative scores of the summary components of the SF-12v2 reflected a lower physical HRQoL (MHQ 49.4; SD: 23.4) than mental HRQoL (PHQ 74.8; SD: 20.2), and all the dimensions increased one year after surgery, especially those for physical health (PHQ increased 36.8%, p<0.001). Two years later all the dimensions decreased with respect to those of the first year (except Bodily Pain). Scores remained significantly above preoperative ones in the physical health dimensions (PHQ increased 23.9%, p<0.001) and the dimensions of Vitality and Emotional Role decreased significantly. Women showed significantly worse levels of HRQoL than men; no other determinant factors of postoperative HRQoL were found. CONCLUSIONS: HRQoL during the two-year follow-up after myocardial revascularization improved significantly but without reaching the levels of the general Spanish population. The female sex showed significantly lower levels of postoperative health.

Quality of sleep in patients undergoing cardiac surgery during the postoperative period in intensive care. / Calidad del sueño en pacientes sometidos a cirugía cardiaca durante el postoperatorio en cuidados intensivos.

OBJECTIVES: To describe the quality of sleep of patients undergoing cardiac surgery during the first two nights following surgery and identify some of the factors conditioning the nightly rest of these patients in the Intensive Care Unit. METHOD: Observational descriptive study based on applying the Richards-Campbell Sleep Questionnaire through a consecutive sample of patients undergoing cardiac surgery with Intensive Care Unit admission. Simultaneously, a questionnaire assessing different environmental factors existing in the unit as possible conditioning of the night's rest was applied. The association between consumption of opioid and sleep quality was studied. RESULTS: Sample of 66 patients with a mean age of 65±11.57 years, of which 73% were men (N=48). The Richards-Campbell sleep questionnaire garnered average scores of 50.33mm (1.st night) and 53.30mm (2.nd night). The main sleep disturbing factors were discomfort with the different devices, 30.91mm and pain, 30.18mm. The problems caused by environmental noise, 27.5mm or through the voices of the professionals, 26.53mm were also elements of nocturnal discomfort. No statistical association was found between sleep and the distance of the patient with respect to the nursing control area or related to opioid analgesics. CONCLUSIONS: The quality of sleep during the first two nights of Intensive Care Unit admission was "regular". The environmental factors that conditioned the night-time rest of patients were discomfort, pain and ambient noise.

[Evaluation of the postoperative acute pain after heart surgery]. / Evaluación del dolor postoperatorio agudo tras cirugía cardiaca.

INTRODUCTION: Pain is one of the main symptoms reported by patients who have had heart surgery. OBJECTIVES: To describe the pain and explain the possible association among demographics, psychological and biological variables of the patients subjected to heart surgery with pain intensity during the postoperative in the ICU. PATIENTS AND METHOD: A descriptive, longitudinal study conducted between February 2008 and January 2009 on patients subjected to heart surgery with admission to the ICU of the Hospital of Navarra was conducted. A preoperatory interview was made with registration of sociodemographic, biological and psychological variables. Pain intensity was monitored during the first 48 hours of ICU stay with the Verbal Numeric Scale (VNS) of pain. Accepted level of significance was p<0.05. RESULTS: A sample of 69 patients with mean age of 62, 26% women and 74% men was included. A superior statistical association was found between postoperative pain levels for age<65 years, bypass grafting with internal mammary artery and preoperatory anxiety variables. There was a significant increase in analgesic consumption for incomes>1400 €/month, bypass grafting with internal mammary artery and preoperatory anxiety. CONCLUSIONS: Postoperative pain after heart surgery show significant individual variability. In our study, age, bypass grafting with internal mammary artery and preoperatory anxiety were shown as predictive variables of postoperative pain in patients undergoing heart surgery.