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John Z. Ayanian, MD, MPP; Edward Guadagnoli, PhD; Paul D. Cleary, PhD

JAMA. 1995;274(22):1767-1770.

Abstract
Objective.
—To assess whether physical and psychosocial functioning differs between women and men after coronary artery bypass surgery.

Design.
—Observational cohort study.

Setting.
—Major teaching hospital.

Patients.
—A total of 454 consecutive patients who received coronary artery bypass surgery from June 1989 through March 1990.

Main Outcome Measures.
—Nurse reviewers collected data on the severity of coronary artery disease and coexisting illnesses from medical records. A mailed survey measuring instrumental activities of daily living (IADLs), social activities, mental health, and vitality was completed by 306 (70.2%) of 436 patients who were alive 6 months after surgery. Functioning on each scale was adjusted for age, marital status, education, severity of angina, recent myocardial infarction, congestive heart failure, and coexisting illnesses at the time of surgery.

Results.
—Before surgery, women were much more likely than men to have had class IV angina (50.9% vs 30.4%), a recent myocardial infarction (32.1% vs 18.0%), and congestive heart failure (34.0% vs 17.6%) (all P<.002). On a range from 0 (severe impairment) to 100 (no impairment), adjusted postoperative functioning was equivalent for women and men in IADLs (86.7 vs 89.1), social activities (95.2 vs 95.3), mental health (72.6 vs 76.0), and vitality (58.1 vs 62.5) (all P>.20). Women reported similar or greater adjusted improvements than men for IDALs (27.2 vs 19.6, P=.08), social activities (20.8 vs 8.0, P=.002), mental health (11.2 vs 5.7, P=.05), and vitality (22.2 vs 12.9, P=.04).

Conclusions.
—Women were more severely ill than men at the time of coronary artery bypass surgery, but women and men reported similar physical and psychosocial functioning 6 months after surgery. These findings demonstrate important functional benefits of this procedure among both women and men.

(JAMA. 1995;274:1767-1770)

Author Affiliations
From the Division of General Medicine (Section on Health Services and Policy Research), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (Dr Ayanian), and the Department of Health Care Policy, Harvard Medical School (Drs Guadagnoli and Cleary), Boston, Mass. Dr Ayanian is a Generalist Physician Faculty Scholar of the Robert Wood Johnson Foundation. Dr Guadagnoli is a Picker/ Commonwealth Scholar.

Footnotes
Reprint requests to Department of Health Care Policy, Harvard Medical School, 25 Shattuck St, Parcel B, First Floor, Boston, MA 02115 (Dr Ayanian).

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