Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000300006
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação da qualidade de vida e mortalidade em pacientes com eventos cardíacos graves no pós-operatório

Quality of life and mortality assessment in patients with major cardiac events in the postoperative period

Fernando José Abelha; Miguela Botelho; Vera Fernandes; Henrique Barros

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Resumo

JUSTIFICATIVA E OBJETIVOS: Complicações cardiovasculares no pós-operatório associam-se a elevadas mortalidade e morbidade. Poucos estudos avaliaram o grau de dependência desses doentes e a percepção da sua saúde. O objetivo deste trabalho foi avaliar a mortalidade e a qualidade de vida em doentes que desenvolveram eventos cardíacos graves (EC) no pós-operatório. MÉTODO: Estudo retrospectivo numa Unidade de Tratamento Intensivo Cirúrgica (UTI-Cirúrgica), entre março de 2006 e março de 2008. Os doen tes foram avaliados quanto à ocorrência de EC. Seis meses após a alta, foi preenchido o questionário Short-Form-36 (SF-36) e avaliada a dependência nas atividades da vida diária (AVD). As comparações entre grupos independentes de doentes foram efetuadas com teste t de Student. A comparação entre cada variável e a ocorrência de EC foi efetuada por regressão logística envolvendo todos os doentes. RESULTADOS: Dos 1.280 doentes que apresentaram critérios de inclusão, 26 (2%) desenvolveram EC. A análise univariada identificou como determinantes independentes para o desenvolvimento de EC: estado físico ASA, hipertensão arterial, doença cardíaca isquêmica, doença cardíaca congestiva e escore do Índice de Risco Cardíaco Revisado. A mortalidade seis meses após alta da UTI-Cirúrgica foi de 35%. Dos 17 sobreviventes aos seis meses, 13 completaram os questionários. Trinta e um por cento referiram que sua saúde em geral era melhor no dia em que responderam ao questionário do que 12 meses antes. Sessenta e nove por cento dos doentes estavam dependentes nas AVD instrumentais e 15%, nas AVD pessoais. CONCLUSÕES: O desenvolvimento de EC tem sério impacto no tempo de hospitalização e nas taxas de mortalidade. Seis meses após a alta da UTI-Cirúrgica, mais de metade dos doentes estavam dependentes em pelo menos uma AVD instrumental.

Palavras-chave

CIRURGIA, CIRURGIA, CIRURGIA, COMPLICAÇÕES, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Cardiovascular complications in the postoperative period are associated with high mortality and morbidity. Few studies have assessed the degree of dependence in these patients and their perception of health. The objective of this study was to assess the mortality and the quality of life in patients who developed major cardiac events (MCE) in the postoperative period. METHOD: Retrospective study carried out in a Surgical Intensive Care Unit (SICU), between March 2006 and March 2008. The patients were assessed regarding the occurrence of CE. Six months after the hospital discharge, the Short-Form-36 (SF-36) questionnaire was filled out and dependence was assessed in relation to activities of daily living (ADL). The comparisons between independent groups of patients were carried out using Student's t test. The comparison between each variable and the occurrence of CE was carried out by logistic regression and included all patients. RESULTS: Of the 1,280 patients that met the inclusion criteria, 26 (2%) developed MCE. The univariate analysis identified as independent determinants for the development of major cardiac events: ASA physical status, hypertension, ischemic heart disease, congestive heart disease and score of the Revised Cardiac Risk Index (RCRI). The six-month mortality after the SICU discharge was 35%. Of the 17 surviving patients, 13 completed the questionnaires. Thirty-one percent of them reported that their general health was better on the day they answered the questionnaire, when compared to 12 months before. Sixty-nine percent of the patients were dependent in instrumental ADL e 15% in personal ADL. CONCLUSIONS: The development of MCE has a significant impact on the duration of hospital stay and mortality rates. Six months after the discharge from the SICU, more than 50% of the patients were dependent in at least one instrumental ADL.

Keywords

COMPLICATIONS, COMPLICATIONS, COMPLICATIONS, SURGERY, SURGERY

References

Lawrence VA, Hilsenbeck SG, Mulrow CD. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med. 1995;10:671-678.

Mangano DT, Browner WS, Hollenberg M. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery: The Study of Perioperative Ischemia Research Group. N Engl J Med. 1990;323:1781-1788.

Kumar R, McKinney WP, Raj G. Adverse cardiac events after surgery: assessing risk in a veteran population. J Gen Intern Med. 2001;16:507-518.

Maia PC, Abelha FJ. Predictors of major postoperative cardiac complications in a surgical ICU. Rev Port Cardiol. 2008;27:321-328.

Lee TH, Marcantonio ER, Mangione CM. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-1049.

Ware JE, Snow KK, Kosinski M. SF-36 Health Survey: Manual and Interpretation Guide. 1993.

Fernandez RR, Cruz JJ, Mata GV. Validation of a quality of life questionnaire for critically ill patients. Intensive Care Med. 1996;22:1034-1042.

Niskanen M, Ruokonen E, Takala J. Quality of life after prolonged intensive care. Crit Care Med. 1999;27:1132-1139.

Patrick DL, Danis M, Southerland LI. Quality of life following intensive care. J Gen Intern Med. 1988;3:218-223.

EuroQol: a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199-208.

McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247-263.

Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473-483.

Ferreira PL. Criação da versão portuguesa do MOS SF-36: Parte I: Adaptação cultural e linguística. Acta Med Port. 2000;13:55-66.

Ferreira PL. Criação da versão portuguesa do MOS SF-36: Parte II: Testes de validação. Acta Med Port. 2000;13:119-127.

Weinert CR, Gross CR, Kangas JR. Health-related quality of life after acute lung injury. Am J Respir Crit Care Med. 1997;156:1120-1128.

Katz S, Ford AB, Moskowitz RW. Studies of illness in the aged: The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914-919.

Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179-186.

Owens WD, Felts JA, Spitznagel EL. ASA Physical Status Classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239-243.

Knaus WA, Draper EA, Wagner DP. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-829.

Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957-2963.

Alpert JS, Thygesen K, Antman E. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36:959-969.

Severo M, Santos AC, Lopes C. Fiabilidade e validade dos conceitos teóricos das dimensões de saúde física e mental da versão Portuguesa do MOS SF-36. Acta Med Port. 2006;19:281-287.

ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg. 2008;106:685-712.

Nesher N, Alghamdi AA, Singh SK. Troponin after cardiac surgery: a predictor or a phenomenon?. Ann Thorac Surg. 2008;85:1348-1354.

Mangano D, Layug EL, Wallace A. Efect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med. 1996;335:1713-1720.

, . Predicting outcome in ICU patients: 2nd European Consensus Conference in Intensive Care Medicine. Intensive Care Med. 1994;20:390-397.

Gijsen R, Hoeymans N, Schellevis FG. Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001;54:661-674.

Giannice R, Foti E, Poerio A. Perioperative morbidity and mortality in elderly gynecological oncological patients (> 70 Years) by the American Society of Anesthesiologists physical status classes. Ann Surg Oncol. 2004;11:219-225.

Lee TH, Marcantonio ER, Mangione CM. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-1049.

Röhrig R, Junger A, Hartmann B. The Incidence and prediction of automatically detected intraoperative cardiovascular events in noncardiac surgery. Anesth Analg. 2004;98:569-577.

Kertai MD, Klein J, Bax JJ. Predicting perioperative cardiac risk. Prog Cardiovasc Dis. 2005;47:240-257.

Hernandez AF, Whellan DJ, Stroud S. Outcomes in heart failure patients after major noncardiac surgery. J Am Coll Cardiol. 2004;44:1446-1453.

Goldman L, Caldera DL, Nussbaum SR. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845-850.

Raby KE, Barry J, Creager MA. Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA. 1992;268:222-227.

Ashton CM, Petersen NJ, Wray NP. The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery. Ann Intern Med. 1993;118:504-510.

Howell SJ, Sear JW. Perioperative myocardial injury: individual and population implications. Br J Anaesth. 2004;93:3-8.

Venkataraman R. Vascular surgery critical care: perioperative cardiac optimization to improve survival. Crit Care Med. 2006;34(^s9 Suppl):S200-207.

Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51:903-912.

Lloyd AJ, Hayes PD, London NJ. Does carotid endarterectomy lead to a decline in cognitive function or health related quality of life?. J Clin Exp Neuropsychol. 2004;26:817-825.

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