Advertisement

Gesundheitsbezogene Lebensqualität nach herzchirurgischen Eingriffen

  • Colleen G. KochEmail author
Chapter
  • 570 Downloads

Zusammenfassung

Die eingeschränkte Lebensqualität und die Krankheitssymptome wecken in den Patienten die Hoffnung, der geplante chirurgische Eingriff werde die Lebensqualität verbessern. Der vom Patienten wahrgenommene Erfolg einer Operation bzw. die subjektive Belastung seines Gesundheitszustands durch eine bestimmte Erkrankung wird mithilfe von patientenzentrierten Beurteilungsinstrumenten bewertet. Traditionell umfassen Risikomodelle zur Beurteilung einer chirurgischen Intervention „harte“ Erfolgsparameter wie Morbidität und Mortalität, während dem subjektiv vom Patienten wahrgenommenen Erfolg eines Eingriffs häufig weniger Aufmerksamkeit beigemessen wurde. Dass den Erfolgsparametern der gesundheitsbezogenen Lebensqualität (health-related quality of life, HRQOL) bisher weniger Beachtung geschenkt wurde, könnte zum Teil daran liegen, dass es sich hierbei um „weiche“ Parameter handelt; ein weiterer Grund könnten die bisher weniger erforschten Messgrößen der Lebensqualität sein bzw. die Unsicherheit darüber, welche statistischen Ansätze sich auf dem Gebiet der Lebensqualität am besten zur Datenanalyse eignen. Manche Autoren betonen, dass die traditionellen Messgrößen der Morbidität und Mortalität keine umfassenden Informationen liefern und dass die HRQOL-bezogenen Messinstrumente die Ärzte in die Lage versetzen, sich bei der Therapie mehr auf den Patienten zu konzentrieren als auf die Erkrankung. Auf dem Gebiet der Herzchirurgie bieten die HRQOL-Parameter eine messbare Beurteilung des Patientennutzen im Hinblick auf die Wiederherstellung der Lebensqualität nach herzchirurgischen Eingriffen. Des Weiteren können diese Instrumente die Prognosegenauigkeit verbessern, indem sie die traditionellen Modelle der Risikobeurteilung hinsichtlich der Morbiditäts- und Mortalitätsergebnisse nach dem Eingriff ergänzen.

Literatur

  1. Artinian NT, Duggan CH (1995) Sex differences in patient recovery patterns after coronary artery bypass surgery. Heart Lung 24:483–494PubMedGoogle Scholar
  2. Ayanian J, Guadagnoli E, Cleary P (1995) Physical and psychosocial functioning of women and men after coronary artery bypass surgery. J Am Med Assoc 274:1767–1770Google Scholar
  3. Bapat V, Allen D, Young C, Roxburgh J, Ibrahim M (2005) Survival and quality of life after cardiac surgery complicated by prolonged intensive care. J Card Surg 20:212–217PubMedGoogle Scholar
  4. Carey J, Cukingnan R, Singer L (1995) Health status after myocardial revascularization: inferior results in women. Ann Thorac Surg 59:112–117PubMedGoogle Scholar
  5. Chaturvedi RK, Blaise M, Verdon J, Iqbal S, Ergina P, Cecere R et al (2010) Cardiac surgery in octogenarians: long-term survival, functional status, living arrangements, and leisure activities. Ann Thorac Surg 89:805–810PubMedGoogle Scholar
  6. Chocron S, Etievent JP, Viel JF et al (1996a) Prospective study of quality of life before and after open heart operations. Ann Thorac Surg 61:153–157PubMedGoogle Scholar
  7. Chocron S, Rude N, Dussaucy A et al (1996b) Quality of life after open-heart surgery in patients over 75 years old. Age Ageing 25:8–11PubMedGoogle Scholar
  8. Chocron S, Etievent JP, Viel JF, Dussaucy A, Clement F, Kaili D, Yan Y (2000) Preoperative quality of life as a predictive factor of 3-year survival after open heart operations. Ann Thorac Surg 69:722–727PubMedGoogle Scholar
  9. Colak Z, Segotic I, Uzun S, Mazar M, Ivancan V, Majeric-Kogler V (2008) Health related quality of life following cardiac surgery: correlation with EuroSCORE. Eur J Cardiothorac Surg 33:72–76PubMedGoogle Scholar
  10. Curtis LH, Phelps CE, McDermott MP, Rubin HR (2002) The value of patient-reported health status in predicting short-term outcomes after coronary artery bypass graft surgery. Med Care 40:1090–1100PubMedGoogle Scholar
  11. Dimopoulou I, Anthi A, Michalis A, Tzelepis GE (2001) Functional status and quality of life in long-term survivors of cardiac arrest after cardiac surgery. Crit Care Med 29:1408–1411PubMedGoogle Scholar
  12. Falcoz PE, Chocron S, Stoica L, Kaili D, Puyraveau M, Mercier M, Etievent JP (2003) Open heart surgery: one-year self-assessment of quality of life and functional outcome. Ann Thorac Surg 76:1598–1604PubMedGoogle Scholar
  13. Fruitman DS, MacDougall CE, Ross DB (1999) Cardiac surgery in octogenarians: can elderly patients benefit? Quality of life after cardiac surgery. Ann Thorac Surg 68:2129–2135PubMedGoogle Scholar
  14. Gardner SC, Grunwald GK, Rumsfeld JS, Cleveland JC Jr, Schooley LM, Gao D et al (2004) Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery. Ann Thorac Surg 77:549–556PubMedGoogle Scholar
  15. Gaudino M, Girola F, Piscitelli M, Martinelli L, Anselmi A, Della Vella C et al (2007) Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay: unmasking an apparent success. J Thorac Cardiovasc Surg 134:465–469PubMedGoogle Scholar
  16. Gersbach P, Tevaearai H, Revelly JP, Bize P, Chiolero R, von Segesser LK (2006) Are there accurate predictors of long-term vital and functional outcomes in cardiac surgical patients requiring prolonged intensive care? Eur J Cardiothorac Surg 29:466–472PubMedGoogle Scholar
  17. Goldsmith IR, Lip GY, Patel RL (2001) A prospective study of changes in patients’ quality of life after aortic valve replacement. J Heart Valve Dis 10:346–353PubMedGoogle Scholar
  18. Goyal S, Henry M, Mohajeri M (2005) Outcome and quality of life after cardiac surgery in octogenarians. ANZ J Surg 75:429–435PubMedGoogle Scholar
  19. Herlitz J, Wiklund I, Caidahl K, Karlson BW, Sjöland H, Hartford M et al (1999) Determinants of an impaired quality of life five years after coronary artery bypass surgery. Heart 81:342–346PubMedPubMedCentralGoogle Scholar
  20. Herlitz J, Brandrup-Wognsen G, Evander MH, Libungan B, Sjöland H, Caidahl K et al (2009) Quality of life 15 years after coronary artery bypass grafting. Coron Artery Dis 20:363–369PubMedGoogle Scholar
  21. Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM et al (1989) A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol 64:651–654PubMedGoogle Scholar
  22. Ho PM, Masoudi FA, Peterson PN, Cleveland JC Jr, Schooley LM, Gao D et al (2005) Health-related quality of life predicts mortality in older but not younger patients following cardiac surgery. Am J Geriatr Cardiol 14:176–182PubMedGoogle Scholar
  23. Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J (1998) Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 279:1187–1193PubMedGoogle Scholar
  24. Isgro F, Skuras JA, Kiessling AH, Lehmann A, Saggau W (2002) Survival and quality of life after a long-term intensive care stay. Thorac Cardiovasc Surg 50:95–99PubMedGoogle Scholar
  25. Jaarsma T, Kastermans MC (1997) Recovery and quality of life one year after coronary artery bypass grafting. Scand J Caring Sci 11:67–72PubMedGoogle Scholar
  26. Jarvinen O, Saarinen T, Julkunen J, Huhtala H, Tarkka MR (2003) Changes in health-related quality of life and functional capacity following coronary artery bypass graft surgery. Eur J Cardiothorac Surg 24:750–756PubMedGoogle Scholar
  27. Jideus L, Liss A, Stahle E (2009) Patients with sternal wound infection after cardiac surgery do not improve their quality of life. Scand Cardiovasc J 43:194–200PubMedGoogle Scholar
  28. Jokinen JJ, Hippelainen MJ, Hanninen T, Turpeinen AK, Hartikainen JE (2008) Prospective assessment of quality of life of octogenarians after cardiac surgery: factors predicting long-term outcome. Interact Cardiovasc Thorac Surg 7:813–818PubMedGoogle Scholar
  29. Khan JH, McElhinney DB, Hall TS, Merrick SH (1998) Cardiac valve surgery in octogenarians: improving quality of life and functional status. Arch Surg 133:887–893PubMedGoogle Scholar
  30. Kirsch M, Guesnier L, LeBesnerais P et al (1998) Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 66:60–67PubMedGoogle Scholar
  31. Koch CG, Khandwala F, Nussmeier N, Blackstone EH (2003a) Gender profiling in coronary artery bypass grafting. J Thorac Cardiovasc Surg 126:2044–2051PubMedGoogle Scholar
  32. Koch CG, Khandwala F, Nussmeier N, Blackstone EH (2003b) Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison. J Thorac Cardiovasc Surg 126:2032–2043PubMedGoogle Scholar
  33. Koch CG, Khandwala F, Cywinski JB, Ishwaran H, Estafanous FG, Loop FD, Blackstone EH (2004) Health-related quality of life after coronary artery bypass grafting: a gender analysis using the Duke Activity Status Index. J Thorac Cardiovasc Surg 128:284–295PubMedGoogle Scholar
  34. Koch CG, Khandwala F, Cywinski JB, Ishwaran H, Estafanous FG, Loop FD (2004) Health-related quality of life after coronary artery bypass grafting: a gender analysis using the Duke Activity Status Index. J Thorac Cardiovasc Surg 128:284–295PubMedGoogle Scholar
  35. Koch CG, Khandwala F, Estafanous FG, Loop FD, Blackstone EH (2005) Impact of prosthesis-patient size on functional recovery after aortic valve replacement. Circulation 111(3):221–229Google Scholar
  36. Koch CG, Khandwala F, Li L, Estafanous FG, Loop FD, Blackstone EH (2006) Persistent effect of red cell transfusion on health-related quality of life after cardiac surgery. Ann Thorac Surg 82:13–20PubMedGoogle Scholar
  37. Koch CG, Li L, Lauer M, Sabik J, Starr NJ, Blackstone EH (2007) Effect of functional health-related quality of life on long-term survival after cardiac surgery. Circulation 115:692–699PubMedGoogle Scholar
  38. Koch CG, Khandwala F, Blackstone EH (2008a) Health-related quality of life after cardiac surgery. Semin Cardiothorac Vasc Anesth 12:203–217PubMedGoogle Scholar
  39. Koch CG, Li L, Shishehbor M, Nissen S, Sabik J, Starr NJ, Blackstone EH (2008b) Socioeconomic status and comorbidity as predictors of preoperative quality of life in cardiac surgery. J Thorac Cardiovasc Surg 136:665–672PubMedGoogle Scholar
  40. Levin IL, Olivecrona GK, Thulin LI, Olsson SB (1998) Aortic valve replacement in patients older than 85 years: outcomes and the effect on their quality of life. Coron Artery Dis 9:373–380PubMedGoogle Scholar
  41. Maliwa MA, van der Heijden GJ, Bots ML et al (2003) Quality of life and NYHA class 30 years after mechanical aortic valve replacement. Cardiovasc Surg 11:381–387PubMedGoogle Scholar
  42. Mayer C, Ergina P, Morin JF, Gold S (2003) Self-reported functional status as a predictor of coronary artery bypass graft surgery outcome in elderly patients. Can J Cardiol 19:140–144PubMedGoogle Scholar
  43. Mittermair RP, Muller LC (2002) Quality of life after cardiac surgery in the elderly. J Cardiovasc Surg 43:43–47Google Scholar
  44. Myles PS, Viira D, Hunt JO (2006) Quality of life at three years after cardiac surgery: relationship with preoperative status and quality of recovery. Anaesth Intensive Care 34:176–183PubMedGoogle Scholar
  45. Nelson CL, Herndon JE, Mark DB, Pryor DB, Califf RM, Hlatky MA (1991) Relation of clinical and angiographic factors to functional capacity as measured by the Duke Activity Status Index. Am J Cardiol 68:973–975PubMedGoogle Scholar
  46. Notzold A, Huppe M, Schmidtke C, Blomer P, Uhlig T, Sievers HH (2001) Quality of life in aortic valve replacement: pulmonary autografts versus mechanical prostheses. J Am Coll Cardiol 37:1963–1966PubMedGoogle Scholar
  47. Olsson M, Janfjall H, Orth-Gomer K, Unden A, Rosenqvist M (1996) Quality of life in octogenarians after valve replacement due to aortic stenosis: a prospective comparison with younger patients. Eur Heart J 17:583–589PubMedGoogle Scholar
  48. Pappalardo F, Franco A, Landoni G, Cardano P, Zangrillo A, Alfieri O (2004) Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery. Eur J Cardiothorac Surg 25:548–552PubMedGoogle Scholar
  49. Perchinsky M, Henderson C, Jamieson WR et al (1998) Quality of life in patients with bioprostheses and mechanical prostheses: evaluation of cohorts of patients aged 51 to 65 years at implantation. Circulation 98(19 suppl):II81–II86PubMedGoogle Scholar
  50. Peric V, Borzanovic M, Stolic R, Jovanovic A, Sovtic S, Dimkovic S, Marcetic Z (2008) Predictors of worsening of patients’ quality of life six months after coronary artery bypass surgery. J Card Surg 23:648–654PubMedGoogle Scholar
  51. Pocock SJ, Henderson RA, Seed P, Treasure T, Hampton JR (1996) Quality of life, employment status, and anginal symptoms after coronary angioplasty or bypass surgery. 3-year follow-up in the Randomized Intervention Treatment of Angina (RITA) Trial. Circulation 94:135–142PubMedGoogle Scholar
  52. Pupello DF, Bessone LN, Lopez E et al (2001) Long-term results of the bioprosthesis in elderly patients: impact on quality of life. Ann Thorac Surg 71:S244–S248PubMedGoogle Scholar
  53. Rumsfeld JS (2002) Health status and clinical practice: when will they meet? Circulation 106:5–7PubMedGoogle Scholar
  54. Rumsfeld JS, MaWhinney S, McCarthy M Jr, Shroyer AL, VillaNueva CB, O’Brien M et al (1999) Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery. JAMA 281:1298–1303PubMedGoogle Scholar
  55. Rumsfeld JS, Magid DJ, O’Brien M, McCarthy M Jr, MaWhinney S, Shroyer AL, Moritz TE, Department of Veterans Affairs Cooperative Study in Health Services: Processes, Structures, and Outcomes of Care in Cardiac Surgery et al (2001) Changes in health-related quality of life following coronary artery bypass graft surgery. Ann Thorac Surg 72:2026–2032PubMedGoogle Scholar
  56. Sedrakyan A, Vaccarino V, Paltiel AD et al (2003) Age does not limit quality of life improvement in cardiac valve surgery. J Am Coll Cardiol 42:1208–1214PubMedGoogle Scholar
  57. Shapira OM, Kelleher RM, Zelingher J et al (1997) Prognosis and quality of life after valve surgery in patients older than 75 years. Chest 112:885–894PubMedGoogle Scholar
  58. Sjogren J, Thulin LI (2004) Quality of life in the very elderly after cardiac surgery: a comparison of SF-36 between long-term survivors and an age-matched population. Gerontology 50:407–410PubMedGoogle Scholar
  59. Sjoland H, Wiklund I, Caidahl K, Haglid M, Westberg S, Herlitz J (1996) Improvement in quality of life and exercise after coronary bypass surgery. Arch Intern Med 156:265–271PubMedGoogle Scholar
  60. Sjoland H, Wiklund I, Caidahl K, Hartford M, Karlsson T, Herlitz J (1999) Improvement in quality of life differs between women and men after coronary artery bypass surgery. J Intern Med 245:445–454PubMedGoogle Scholar
  61. Spertus JA, Jones P, McDonell M, Fan V, Fihn SD (2002) Health status predicts long-term outcome in outpatients with coronary disease. Circulation 106:43–49PubMedGoogle Scholar
  62. Stewart R, Blair J, Emond C, Lahey S, Levitsky S, Campos C (1999) Gender and functional outcome after coronary artery bypass. Surgery 126:184–190PubMedGoogle Scholar
  63. Sundt TM, Bailey MS, Moon MR et al (2000) Quality of life after aortic valve replacement at the age of >80 years. Circulation 102:S70–S74Google Scholar
  64. Vaccarino V, Lin ZQ, Kasl SV, Mattera JA, Roumanis SA, Abramson JL, Krumholz HM (2003) Gender differences in recovery after coronary artery bypass surgery. J Am Coll Cardiol 41:307–314PubMedGoogle Scholar
  65. Welke KF, Stevens JP, Schults WC, Nelson EC, Beggs VL, Nugent WC (2003) Patient characteristics can predict improvement in functional health after elective coronary artery bypass grafting. Ann Thorac Surg 75:1849–1855PubMedGoogle Scholar
  66. Williams MR, Wellner RB, Hartnett EA, Thornton B, Kavarana MN, Mahapatra R et al (2002) Long-term survival and quality of life in cardiac surgical patients with prolonged intensive care unit length of stay. Ann Thorac Surg 73:1472–1478PubMedGoogle Scholar
  67. Yamaguchi H, Yamauchi H, Yamada T, Ariyoshi T, Takebayashi S (2000) Quality of life in patients over 70 years of age after heart valve replacement. Ann Thorac Cardiovasc Surg 6:167–172PubMedGoogle Scholar
  68. Yun KL, Sintek CF, Fletcher AD, Pfeffer TA, Kochamba GS, Mahrer PR, Khonsari S (1999) Time related quality of life after elective cardiac operation. Ann Thorac Surg 68:1314–1320PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical Care MedicineJohns Hopkins UniversityBaltimoreUSA

Personalised recommendations