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J Thorac Cardiovasc Surg 2004;128:284-295
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Health-related quality of life after coronary artery bypass grafting: A gender analysis using the Duke Activity Status Index

^a Department of Cardiothoracic Anesthesia (G-3), The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^b Department of Biostatistics, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^c Department of General Anesthesiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^d Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Received for publication September 12, 2003; revisions received December 2, 2003; accepted for publication December 12, 2003.

^* Address for reprints: Colleen Gorman Koch, MD, MS, Department of Cardiothoracic Anesthesia (G-3), The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
kochc{at}ccf.org

OBJECTIVE: Our objectives were to document the preoperative and postoperative functional status of patients undergoing coronary artery bypass grafting, to examine factors that influence functional recovery, and to determine whether gender differences exist in the preoperative and postoperative functional status with the Duke Activity Status Index.

METHODS: One thousand eight hundred twenty-five patients undergoing isolated coronary artery bypass grafting had baseline and follow-up quality-of-life surveys. Mean follow-up from baseline to postoperative Duke Activity Status Index was 8.0 months for women and men. The influence of 47 variables, in addition to baseline scores on postoperative functional status, was examined with logistic ordinal modeling. An ordinal model for the follow-up score was determined by means of backward selection, with variables retained if they satisfied the criterion of a P value of less than .05.

RESULTS: Median baseline Duke Activity Status Index scores (women, 21.5; men, 32.2; P < .001) and first follow-up scores (women, 42.7; men, 58.2; P < .001) were lower in women than in men. Patients who were older and those who had chronic obstructive pulmonary disease, myocardial infarction, stroke, diabetes, vascular disease, postoperative serious infection, and return to the operating room had lower postoperative scores. After adjusting for these factors, women still had lower follow-up scores (odds ratio for men, 2.1 [95% confidence interval, 1.7-2.6]; P < .001).

CONCLUSIONS: A number of preoperative factors, operative variables, and postoperative events are associated with functional recovery after coronary revascularization. In addition, female gender is associated with more postoperative functional impairment after adjusting for these perioperative variables.

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