Page 124 - Encyclopedia of Nursing Research

CoRonARY ARTERY BYPASS GRAFT SURGERY n 91

in patient’s depression and/or anxiety posto- to 100% Caucasian. Most investigators found
peratively. that anxiety levels significantly decreased
The most common predictor of postop- over time and remained linear. Postoperative C
erative anxiety was preoperative anxiety. anxiety was directly related to perception of
The impact of gender and age was equivocal pain with the strongest relationship on post-
with some studies identifying age as predic- operative Day 2. neither gender nor age was
tive and an equal number finding it not pre- significantly associated with level of pain
dictive. one study identified a relationship (nelson, Zimmerman, Barnason, nieveen, &
between age and anxiety (Krannich et al., Schmaderer, 1998). In a large study with 1,317
2007). Although younger patients were more patients, there was a dose–response relation-
anxious before surgery and showed a decline ship between state anxiety and risk of death
in symptoms after surgery, anxiety symp- or myocardial infarction but no association
toms in older patients showed little change between self-reported anxiety and athero-
(Krannich et al., 2007). sclerotic progression of grafts (Wellenius,
As with the findings related to anxiety, Mukamal, Kulshreshtha, Asonganyi, &
the most frequently identified predictor of Mittleman, 2008). In one study, patients with
postoperative depression was preoperative chronic postoperative pain had significantly
depression. In studies with women, female higher levels of anxiety and depression
gender was a frequently reported predictor than those without chronic pain (Taillefer
of postoperative depression, but the impact et al., 2006). The mechanism by which anx-
of age was equivocal. A conclusion from the iety increases mortality and morbidity is
systematic review was that the most com- not yet understood (Rosenbloom, Wellenius,
mon predictors of postoperative anxiety and Mukamal, & Mittleman, 2009).
depression were preoperative levels. one Longitudinal studies evaluating depres-
consistent recommendation was that clini- sion reported prevalence rates ranging from
cians needed to routinely assess patients’ 16% to 50% preoperatively and from 17% to
depression and anxiety before surgery to 61% postoperatively. Almost all studies used
identify those patients at greater risk for post- self-report questionnaires. Subjects’ (n = 50 to
operative difficulties. In keeping with these 759) mean ages ranged from 54 to 70 years,
recommendations, screening for depression most represented a 3:1 male-to-female ratio,
in patients with coronary heart disease has and ranged from 82% to 100% Caucasian.
recently been recommended by the American In addition to preoperative depression lev-
Heart Association (Lichtman et al., 2008). In els, investigators have identified predictors
addition, with more women and older adults of postoperative depression as poor social
undergoing CABG surgery, the impact of age support, at least one stressful life event in the
and gender on postoperative recovery needs last year, low level of education, and mod-
to be further explored. erate to severe dyspnea (Pirraglia, Peterson,
A number of studies have examined the Williams-Russo, Gorkin, & Charlson, 1999).
course and outcomes of anxiety for patients one study found that 6 weeks after surgery,
undergoing CABG surgery. Longitudinal fatigued older patients (>65 years) had sig-
studies evaluating anxiety reported prev- nificantly higher anxiety and depressive
alence rates ranging from 4% to 50% symptoms with residual aspects of hav-
preoperatively and from 25% to 61% post- ing higher anxiety (experiencing panic and
operatively. Almost all studies used self- worry) remaining high at 3 months (Barnason
report questionnaires for measuring anxiety. et al., 2008). Depression has consistently been
Subjects’ (n = 35 to 1,317) mean ages ranged associated with adverse cardiac outcomes
from 54 to 70 years, most represented a 3:1 after CABG surgery. Investigators have found
male-to-female ratio, and ranged from 82% depressive symptoms, pre- or postoperatively