Page 125 - Encyclopedia of Nursing Research

92 n CoRonARY ARTERY BYPASS GRAFT SURGERY

predict postoperative cardiac events (unsta- were no significant differences (vaccarino,
ble angina, myocardial infarction, repeat 2003). vaccarino, Abramson, veledar, and
C CABG, or angioplasty), and are positively Weintraub (2002) found that women under-
correlated with the rate of readmission for going CABG surgery were older, less edu-
cardiac events (Perski et al., 1998; Saur et al., cated, had more severe and unstable angina,
2001; Scheier et al., 1999). Connerney, Shapiro, had congestive heart failure, had lower func-
McLaughlin, Bagiella, and Sloan (2001) deter- tional status, and had more depressive symp-
mined that patients meeting criteria for toms in the month before surgery. Younger
major depressive disorder at discharge were women were at a higher risk of in-hospital
significantly more likely to experience a death than men, a difference decreasing with
cardiac-related event. Furthermore, depres- age. In a Canadian study, investigators found
sion was a predictor independent of classic that after adjusting for age and comorbid
cardiovascular risk factors. Both increased conditions, female gender was associated
preoperative depression and postoperative with a 10% increase in length of stay, a 97%
anxiety were identified as risk factors for increase in mortality, and a 7% increase in
cardiac-related hospital admissions within overall cost (Bestawros, Filion, Haider, Pilote,
6 months of surgery (oxlad, Stubberfield, & Eisenberg, 2005). In contrast to the earlier
Stuklis, Edwards, & Wade, 2006). In addition, findings, a recent study in Japan found that
postoperative depression was associated the clinical outcomes for females after CABG
with infections, impaired wound healing, surgery were comparable with those of males
poor emotional and physical recovery, and (Fukui & Takanashi, 2010).
a higher risk of atherosclerotic progression Postoperative neuropsychological defi-
among patients with saphenous vein grafts cits can be complications of cardiac surgery.
(Doering, Moser, Lemankiewicz, Luper, & A group of investigators in China found
Khan, 2005; Wellenius et al., 2008). that patients undergoing surgery with
Blumenthal et al. (2003) identified higher bypass exhibited more neuropsychologi-
mortality rates for patients with moderate cal deficits and anxiety than those patients
to severe depression at baseline and mild or whose surgeries were completed off pump.
moderate to severe depression that persisted Investigators found that depression and
from baseline to 6 months. In contrast to the anxiety were correlated with some factors
finding of the earlier studies, a more recent of cognitive dysfunction (Yin, Luo, Guo, Li,
study suggested that preoperative depres- & Huang, 2007). In contrast to these results,
sion was not associated with a significantly Stroobant and vingerhoets (2008) found that
higher risk for mortality, but after adjust- off-pump patients showed higher cognitive–
ment for known mortality risk factors, preop- affective depression scores than on-pump
erative anxiety symptoms were significantly patients. on-pump patients generally
associated with increased all-cause mortality showed no depression, whereas off-pump
risk. Investigators identified that there was patients had a mild depression that contin-
a trend toward significance of depressive ued for 3 to 5 years after surgery. In another
symptoms and mortality risk, but the signif- study, no differences were found between
icance may have been attenuated by the use patients undergoing surgery on and off
of psychotropic medications (Tully, Baker, & pump. Although significant improvement
Knight, 2008). was identified in state anxiety and depres-
Several studies have addressed gender sive symptoms, the number of patients with
differences in recovery from CABG surgery. depressive symptoms remained constant.
In some studies, women had more symp- Unlike other studies, patients in this sam-
toms and poorer functioning after CABG ple reported significant subjective improve-
than men, whereas in other studies, there ment in concentration and memory (Sandau,