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John S. Rumsfeld, MD; Samantha MaWhinney, ScD; Martin McCarthy, Jr, PhD; A. Laurie W. Shroyer, PhD; Catherine B. VillaNueva, RN, MS, MBA; Maureen O'Brien, MS; Thomas E. Moritz, MS; William G. Henderson, PhD; Frederick L. Grover, MD; Gulshan K. Sethi, MD; Karl E. Hammermeister, MD; for the Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery

JAMA. 1999;281:1298-1303.

Context  Health-related quality of life has not been evaluated as a predictor of mortality following coronary artery bypass graft (CABG) surgery. Evaluation of health status as a mortality predictor may be useful for preoperative risk stratification.

Objective  To determine whether the Physical and Mental Component Summary scores from the preoperative Short-Form 36 (SF-36) health status survey predict mortality following CABG surgery after adjustment for known clinical risk variables.

Design  Prospective cohort study conducted between September 1992 and December 1996.

Setting  Fourteen Veterans Affairs hospitals.

Patients  Of the 3956 patients undergoing CABG surgery only and who were enrolled in the Processes, Structures, and Outcomes of Care in Cardiac Surgery study, the 2480 who completed a preoperative SF-36.

Main Outcome Measure  All-cause mortality within 180 days after surgery.

Results  A total of 117 deaths (4.7%) occurred within 180 days of CABG surgery. The Physical Component Summary of the preoperative SF-36 was a statistically significant risk factor for 6-month mortality after adjustment for known clinical risk factors for mortality following CABG surgery. In multivariate analysis, a 10-point lower SF-36 Physical Component Summary score had an odds ratio (OR) of 1.39 (95% confidence interval [CI], 1.11-1.77; P=.006) for predicting mortality. The SF-36 Mental Component Summary score was not associated with 6-month mortality in multivariate analyses (OR, 1.09; 95% CI, 0.92-1.29; P=.31).

Conclusions  The Physical Component Summary score from the preoperative SF-36 is an independent risk factor for mortality following CABG surgery. The baseline Mental Component Summary score does not appear to be predictive of mortality. Preoperative patient self-report of the physical component of health status may be helpful for risk stratification and clinical decision making for patients undergoing CABG surgery.

Author Affiliations: Division of Cardiology (Drs Rumsfeld and Hammermeister), Departments of Preventive Medicine and Biometrics (Dr MaWhinney), and Medicine (Dr Shroyer), and Division of Cardiothoracic Surgery (Dr Grover), Health Sciences Center, University of Colorado, Denver; Cardiology Section (Dr Hammermeister), Cardiac Research (Dr Shroyer and Mss VillaNueva and O'Brien), and Surgery Service (Dr Grover), Denver Veterans Affairs Medical Center, Denver, Colo; Department of Preventive Medicine, Northwestern University, Chicago, Ill (Dr McCarthy); Veterans Affairs Cooperative Studies Program Coordinating Center, Hines Veterans Affairs Medical Center, Hines, Ill (Mr Moritz and Dr Henderson); Cardiothoracic Surgery Section, Tucson Veterans Affairs Medical Center, Tucson, Ariz (Dr Sethi); and Department of Surgery, Health Sciences Center, University of Arizona, Tucson (Dr Sethi).
Principal Investigators of the Department of Veterans Affairs Cooperative Study Group on PSOCS: Marvin Kirsh, MD, Ann Arbor, Mich; Stewart Scott, MD (deceased); John Lucke, MD, Asheville, NC; John Handy, MD, Charleston, SC; David Fullerton, MD, Denver, Colo; Donald DePinto, MD, Hines, Ill; H. Gareth Tobler, MD, and Kwabena Mawulawd, MD, Little Rock, Ark; G. Hossein Almassi, MD, Milwaukee, Wis; Herbert Ward, MD, Minneapolis, Minn; Walter Merrill, MD, Nashville, Tenn; Rick Esposito, MD, New York, NY; O. LaWayne Miller, MD, San Antonio, Tex; Gulshan Sethi, MD, Tucson, Ariz; Shukri Khuri, MD, West Roxbury, Mass; and Riyad Tarazi, MD, San Diego, Calif.

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