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Female Gender Is Associated With Impaired Quality of Life 1 Year After Coronary Artery Bypass Surgery

Departments of Anesthesiology (B.P.B., J.M., W.D.W., M.F.N.), Psychiatry and Behavioral Sciences (B.P.B., J.A.B. K.W.-B.), Medicine (D.M.), and Surgery (K.L.), Duke University Medical Center, Durham, NC.

Address correspondence and reprint requests to Barbara Phillips Bute, PhD, Box 3094, DUMC, Duke University Medical Center, Durham, NC 27710. E-mail: phill016{at}mc.duke.edu

OBJECTIVE: To evaluate gender-related differences in quality of life (QOL) and cognitive function 1 year after coronary artery bypass surgery (CABG) after adjusting for known baseline differences.

MATERIALS AND METHODS: Two hundred eighty patients (96 women and 184 men) underwent neurocognitive and QOL evaluation at baseline (preoperatively) and at 1 year after CABG. Multivariable linear regression was used to assess the relationship of gender to follow-up QOL and cognitive function. Measures used to evaluate QOL were IADL, DASI, work activities (SF-36), social activities, social support, general health perception (SF-36), CESD, STAI, and symptom limitations. Cognitive function was measured with a battery of performance-based neuropsychological tests, reduced to a four-cognitive domain scores with factor analysis, and a self-report measure of cognitive difficulties. Covariates in multiple regression models included age, years of education, marital status, Charlson Comorbidity Index, hypertension, diabetes, race, and baseline QOL/cognitive status.

RESULTS: Female patients showed significantly worse outcome than male patients at 1 year follow-up in several key areas of QOL. After adjusting for baseline differences, women are at greater risk for increased cognitive difficulties (p= 0.04) and anxiety (p= 0.03), as well as impaired DASI (p= 0.02), IADL (p= 0.03), and work activities (p= 0.02). Cognitive sequelae attributable to bypass surgery were similar between men and women.

CONCLUSIONS: Even after adjusting for known risk factors for compromised QOL and cognitive functioning, women do not show the same long-term quality benefits of CABG surgery that men do.

Key Words: quality of life, • cognitive function, • CABG surgery, • gender.

Abbreviations: CABG = coronary artery bypass grafting; QOL = quality of life;; WAIS-R = Wechsler Adult Intelligence Scale-Revised;; DASI = Duke Activity Status Index;; OARS-IADL = The Duke Older Americans Resources and Services Procedures-Instrumental Activities of Daily Living;; CES-D = Center for Epidemiological Studies Depression Scale;; CPB = cardiopulmonary bypass;; SF-36 = Medical Outcomes Study 36-Item Short Form Health Survey.

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