MiscellaneousPreoperative Anxiety as a Predictor of Mortality and Major Morbidity in Patients Aged >70 Years Undergoing Cardiac Surgery
Section snippets
Methods
Consecutive patients were screened for study inclusion from 2008 to 2009 at 4 university-affiliated tertiary care centers in the United States and Canada as a part of the Frailty Assessment Before Cardiac Surgery (Frailty ABC'S) study.9 Eligible patients were asked by the study personnel to complete a structured questionnaire that included the HADS and a brief battery of physical performance tests. Mini-mental state examinations were also administered, and patients were asked to grade their
Results
The cohort for these analyses consisted of 148 patients who completed the HADS questionnaire and underwent cardiac surgery within the Frailty ABC'S study. The median interval from questionnaire completion to surgery was 2 days (interquartile range 1 to 3). No patients were lost to follow-up. Figure 1 displays the flow of patients through the present study. The baseline variables stratified by HADS-A score are listed in Table 2: 71% scored 0 to 7 (“no anxiety”); 22% scored 8 to 10 (“possible
Discussion
In the present prospective multicenter study, significant levels of patient-reported preoperative anxiety independently predicted a greater risk of in-hospital mortality or major morbidity in elderly patients undergoing cardiac surgery. This increased hazard persisted even after adjustment for surgical risk (STS risk score) related to traditional risk factors and depressive symptoms. The majority of patients with high levels of anxiety were unlikely to have a clinical diagnosis of general
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Dr. Williams was supported in part by training grant T32-HL069749 from the National Institutes of Health (Bethesda, Maryland) and Drs. Williams, Smith, and Perrault were supported in part by grant U01-HL088953 from the National Institutes of Health Cardiothoracic Surgical Trials Network (Bethesda, Maryland).