Physical and psychosocial functioning of women and men after coronary artery bypass surgery

J. Z. Ayanian, E. Guadagnoli and P. D. Cleary

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 IADLs (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.

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