Page 123 - Encyclopedia of Nursing Research

90 n CoRonARY ARTERY BYPASS GRAFT SURGERY

to improve quality of life (QoL; Dunckley,
C Coronary artery bypass Ellard, Quin, & Barlow, 2008; Hawkes,
nowak, Bidstrup, & Speare, 2006). Although
graFt surgery CABG surgery succeeds in increasing sur-
vival and decreasing angina in most patients,
it is now recognized that adjustment to
Coronary artery bypass graft (CABG) sur- CABG surgery is a multidimensional process
gery is a commonly used revascularization that is not completely explained by medical
procedure for coronary heart disease. An factors (Hawkes et al., 2006). Investigators
estimated 800,000 surgeries are performed have found that a substantial proportion of
worldwide each year (Borowicz et al., 2002), patients do not experience an improvement
with 448,000 performed in the United States in their QoL, with some patients actually
in 2006 (American Heart Association, 2009). experiencing decrease in QoL after sur-
In the United States, CABG surgery uses gery (Hawkes & Mortensen, 2006). In sev-
more healthcare resources than any other sin- eral global studies, researchers examined the
gle procedure and accounted for more than course of changes in QoL as well as longi-
209.3 billion dollars in health care costs in tudinal predictors of QoL. Patients under-
2003 (www.rxpgnews.com). In many devel- going percutaneous coronary interventions
oped countries, demand for CABG surgery experienced a relatively rapid increase in
exceeds resources leading to waiting lists. health-related QoL (HRQL) in the first month
Patients on waiting lists experienced anxiety, with little change by 3 months after surgery.
depression, and negative impacts on quality However, patients undergoing CABG sur-
of life (Fitzsimons, Parahoo, & Stringer, 2000; gery experienced an initial deterioration in
Screeche-Powell & owens, 2003). HRQL and then improved significantly. The
Several randomized controlled trials change in the scores on anxiety and depres-
examined the effectiveness of nurse-led sion accounted for most of the change in
programs for patients awaiting CABG sur- HRQL (Hofer, Doering, Rumpold, oldridge,
gery. Patients awaiting surgery with at least & Benzer, 2006). In a study evaluating the
one poorly controlled risk factor (e.g., high influence of preoperative physical and psy-
blood pressure, high cholesterol, smoking, chosocial functioning on QoL after CABG
etc.) were randomized to standard care or surgery (Panagopoulou, Montgomery, &
a nursing intervention. outcome measures Benos, 2006), researchers identified that pre-
included anxiety, depression, blood pres- operative psychological distress was the
sure, cholesterol level, length of stay, body only predictor of QoL at one month and six
mass index, and costs of hospital expendi- months after surgery.
tures. There were no significant differences Longitudinal studies investigating the
between the groups except for total costs impact of psychological variables on out-
of hospital expenditure, with the interven- comes of CABG surgery demonstrate that
tion group having fewer admissions, and recovery is neither simple nor experienced
therefore lower costs. Depression and anxi- consistently in all patients.
ety scores did decrease for the intervention Although some studies included the
group, but the difference between the groups measurement of only anxiety or depression,
was not statistically significant (Goodman most examined the impact of both anxiety
et al., 2008). and depression on recovery. In a systematic
For patients undergoing CABG surgery, review of preoperative predictors of postop-
there are four goals: to increase survival, erative depression and anxiety, McKenzie,
to relieve symptoms of angina, to reduce Simpson, and Stewart (2010) found that the
the likelihood of future heart attacks, and majority of studies reported an improvement