CHANGE IN FUNCTIONAL STATUS FROM PREOPERATIVE TO ONE YEAR
POSTOPERATIVE IN PATIENTS WHO HAVE UNDERGONE ELECTIVE OPEN HEART
SURGERY: A REPEATED-MEASURES STUDY
A. Kate MacPhedran, MPT, CCS (145 W. 36th Street, Erie, PA 16508)
This research was conducted at Saint Vincent Health Center in Erie, PA from 2010 to 2011, as
part of Ms. MacPhedran’s dissertation work in the Interdisciplinary Health Sciences PhD
Program at Western Michigan University, Kalamazoo, MI.
Abstract: Predictors in heart surgery have evolved since the 1980’s to include not just diseaserelated but patient-related factors affecting surgical outcomes (Akins et al., 2008, Edmunds et
al., 1996). Cardiac surgeons have universally accepted risk score systems such as the
EuroSCORE or Parsonnet score to predict mortality and morbidity, but none of these scores
include measures of patients’ functional status (Geissler et al., 2000). Functional status can be
objectively measured using validated outcome tools such as the Late-Life Function and
Disability Instrument (LLFDI). Purpose: This descriptive, non-experimental survey study was of
prospective longitudinal study design comparing LLFDI functional status scores at preoperative,
six weeks postoperative and one year postoperative in patients who underwent elective
coronary artery bypass and/or valve repair/replacement surgery (n=43) to determine: 1) if there
was a change in functional status over time and 2) what specific aspect(s) of LLFDI functional
status (function or disability component) change. Methods: Postoperative LLFDI questionnaires
were mailed to patients one week prior to each measured time point. 53% (23) of the
preoperative questionnaires were obtained in-person due to admission from consent to surgery.
Repeated-Measures ANOVA was conducted for main effect of time on functional status then
post hoc planned comparison for specific interactions. Results: Attrition rates and incomplete
questionnaires accounted for 21% (n=9) and 12% (n=5) at six weeks and one year
postoperative, respectively. Repeat-measures ANOVA of all three LLFDI questionnaires (n=29)
revealed significant difference in time with disability frequency, F(1.53, 42.70) = 5.49, p= .013, Ɛ
= .763. Post hoc planned comparison using Bonferroni adjustment was significant for disability
frequency from preoperative to one year postoperative (M difference= 5.98, SE=2.19, p=.033
(.400, 11.556) at 95% CI. Group mean changes for disability frequency from preoperative, six
weeks postoperative, to one year postoperative were: M=51.80, SE=1.15; M=52.90, SE=1.52;
M=57.79, SE=2.32 with increased mean indicating decreased disability. Function Total and
Disability Limitation were not statistically significant (p > .05) but had clinical relevance with
increased one year postoperative Disability Limitation (indicating decreased disability) and
Function Total means (M=81.65, SE= 2.87; M=65.82, SE= 2.04, respectively), compared to six
weeks postoperative means for Disability Limitation (M=75.63, SE=2.89) and Total Function
(M=62.97, SE=1.62). Conclusion: Although functional status was not significantly improved as
early as six weeks postoperatively, disability frequency (social life participation) improved
significantly from preoperative to one year postoperative for patients who underwent elective
heart surgery. Clinical Relevance: Aspects of LLFDI functional status should be considered for
inclusion among cardiac risk score measures.
AdrianeKC13@AOL.com
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