Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery

Judson B. Williams, Karen P. Alexander, Jean-françois Morin, Yves Langlois, Nicolas Noiseux, Louis P. Perrault, K.G.E. Smolderen, Suzanne V. Arnold, Mark J. Eisenberg, Louise Pilote, Johanne Monette, Howard Bergman, Peter K. Smith, Jonathan Afilalo

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Abstract

The present study examined the association between patient-reported anxiety and postcardiac surgery mortality and major morbidity. Frailty Assessment Before Cardiac Surgery was a prospective multicenter cohort study of elderly patients undergoing cardiac surgery (coronary artery bypass surgery and/or valve repair or replacement) at 4 tertiary care hospitals from 2008 to 2009. The patients were evaluated a mean of 2 days preoperatively with the Hospital Anxiety and Depression Scale, a validated questionnaire assessing depression and anxiety in hospitalized patients. The primary predictor variable was a high level of anxiety, defined by a Hospital Anxiety and Depression Scale score of ≥11. The main outcome measure was all-cause mortality or major morbidity (e.g., stroke, renal failure, prolonged ventilation, deep sternal wound infection, or reoperation) occurring during the index hospitalization. Multivariable logistic regression analysis examined the association between high preoperative anxiety and all-cause mortality/major morbidity, adjusting for the Society of Thoracic Surgeons predicted risk, age, gender, and depression symptoms. A total of 148 patients (mean age 75.8 ± 4.4 years; 34% women) completed the Hospital Anxiety and Depression Scale. High levels of preoperative anxiety were present in 7% of patients. No differences were found in the type of surgery and Society of Thoracic Surgeons predicted risk across the preoperative levels of anxiety. After adjusting for potential confounders, high preoperative anxiety was remained independently predictive of postoperative mortality or major morbidity (odds ratio 5.1, 95% confidence interval 1.3 to 20.2; p = 0.02). In conclusion, although high levels of anxiety were present in few patients anticipating cardiac surgery, this conferred a strong and independent heightened risk of mortality or major morbidity.
Original languageEnglish
Pages (from-to)137-142
JournalAmerican Journal of Cardiology
Volume111
Issue number1
DOIs
Publication statusPublished - 1 Jan 2013

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Depression
Multicenter Studies
Ventilation
Logistic Models
Odds Ratio
Confidence Intervals

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Williams, J. B., Alexander, K. P., Morin, J., Langlois, Y., Noiseux, N., Perrault, L. P., ... Afilalo, J. (2013). Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. American Journal of Cardiology, 111(1), 137-142. https://doi.org/10.1016/j.amjcard.2012.08.060
Williams, Judson B. ; Alexander, Karen P. ; Morin, Jean-françois ; Langlois, Yves ; Noiseux, Nicolas ; Perrault, Louis P. ; Smolderen, K.G.E. ; Arnold, Suzanne V. ; Eisenberg, Mark J. ; Pilote, Louise ; Monette, Johanne ; Bergman, Howard ; Smith, Peter K. ; Afilalo, Jonathan. / Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. In: American Journal of Cardiology. 2013 ; Vol. 111, No. 1. pp. 137-142.
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abstract = "The present study examined the association between patient-reported anxiety and postcardiac surgery mortality and major morbidity. Frailty Assessment Before Cardiac Surgery was a prospective multicenter cohort study of elderly patients undergoing cardiac surgery (coronary artery bypass surgery and/or valve repair or replacement) at 4 tertiary care hospitals from 2008 to 2009. The patients were evaluated a mean of 2 days preoperatively with the Hospital Anxiety and Depression Scale, a validated questionnaire assessing depression and anxiety in hospitalized patients. The primary predictor variable was a high level of anxiety, defined by a Hospital Anxiety and Depression Scale score of ≥11. The main outcome measure was all-cause mortality or major morbidity (e.g., stroke, renal failure, prolonged ventilation, deep sternal wound infection, or reoperation) occurring during the index hospitalization. Multivariable logistic regression analysis examined the association between high preoperative anxiety and all-cause mortality/major morbidity, adjusting for the Society of Thoracic Surgeons predicted risk, age, gender, and depression symptoms. A total of 148 patients (mean age 75.8 ± 4.4 years; 34{\%} women) completed the Hospital Anxiety and Depression Scale. High levels of preoperative anxiety were present in 7{\%} of patients. No differences were found in the type of surgery and Society of Thoracic Surgeons predicted risk across the preoperative levels of anxiety. After adjusting for potential confounders, high preoperative anxiety was remained independently predictive of postoperative mortality or major morbidity (odds ratio 5.1, 95{\%} confidence interval 1.3 to 20.2; p = 0.02). In conclusion, although high levels of anxiety were present in few patients anticipating cardiac surgery, this conferred a strong and independent heightened risk of mortality or major morbidity.",
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Williams, JB, Alexander, KP, Morin, J, Langlois, Y, Noiseux, N, Perrault, LP, Smolderen, KGE, Arnold, SV, Eisenberg, MJ, Pilote, L, Monette, J, Bergman, H, Smith, PK & Afilalo, J 2013, 'Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery', American Journal of Cardiology, vol. 111, no. 1, pp. 137-142. https://doi.org/10.1016/j.amjcard.2012.08.060

Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. / Williams, Judson B.; Alexander, Karen P.; Morin, Jean-françois; Langlois, Yves; Noiseux, Nicolas; Perrault, Louis P.; Smolderen, K.G.E.; Arnold, Suzanne V.; Eisenberg, Mark J.; Pilote, Louise; Monette, Johanne; Bergman, Howard; Smith, Peter K.; Afilalo, Jonathan.

In: American Journal of Cardiology, Vol. 111, No. 1, 01.01.2013, p. 137-142.

Research output: Contribution to journalArticleScientificpeer-review

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T1 - Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery

AU - Williams, Judson B.

AU - Alexander, Karen P.

AU - Morin, Jean-françois

AU - Langlois, Yves

AU - Noiseux, Nicolas

AU - Perrault, Louis P.

AU - Smolderen, K.G.E.

AU - Arnold, Suzanne V.

AU - Eisenberg, Mark J.

AU - Pilote, Louise

AU - Monette, Johanne

AU - Bergman, Howard

AU - Smith, Peter K.

AU - Afilalo, Jonathan

PY - 2013/1/1

Y1 - 2013/1/1

N2 - The present study examined the association between patient-reported anxiety and postcardiac surgery mortality and major morbidity. Frailty Assessment Before Cardiac Surgery was a prospective multicenter cohort study of elderly patients undergoing cardiac surgery (coronary artery bypass surgery and/or valve repair or replacement) at 4 tertiary care hospitals from 2008 to 2009. The patients were evaluated a mean of 2 days preoperatively with the Hospital Anxiety and Depression Scale, a validated questionnaire assessing depression and anxiety in hospitalized patients. The primary predictor variable was a high level of anxiety, defined by a Hospital Anxiety and Depression Scale score of ≥11. The main outcome measure was all-cause mortality or major morbidity (e.g., stroke, renal failure, prolonged ventilation, deep sternal wound infection, or reoperation) occurring during the index hospitalization. Multivariable logistic regression analysis examined the association between high preoperative anxiety and all-cause mortality/major morbidity, adjusting for the Society of Thoracic Surgeons predicted risk, age, gender, and depression symptoms. A total of 148 patients (mean age 75.8 ± 4.4 years; 34% women) completed the Hospital Anxiety and Depression Scale. High levels of preoperative anxiety were present in 7% of patients. No differences were found in the type of surgery and Society of Thoracic Surgeons predicted risk across the preoperative levels of anxiety. After adjusting for potential confounders, high preoperative anxiety was remained independently predictive of postoperative mortality or major morbidity (odds ratio 5.1, 95% confidence interval 1.3 to 20.2; p = 0.02). In conclusion, although high levels of anxiety were present in few patients anticipating cardiac surgery, this conferred a strong and independent heightened risk of mortality or major morbidity.

AB - The present study examined the association between patient-reported anxiety and postcardiac surgery mortality and major morbidity. Frailty Assessment Before Cardiac Surgery was a prospective multicenter cohort study of elderly patients undergoing cardiac surgery (coronary artery bypass surgery and/or valve repair or replacement) at 4 tertiary care hospitals from 2008 to 2009. The patients were evaluated a mean of 2 days preoperatively with the Hospital Anxiety and Depression Scale, a validated questionnaire assessing depression and anxiety in hospitalized patients. The primary predictor variable was a high level of anxiety, defined by a Hospital Anxiety and Depression Scale score of ≥11. The main outcome measure was all-cause mortality or major morbidity (e.g., stroke, renal failure, prolonged ventilation, deep sternal wound infection, or reoperation) occurring during the index hospitalization. Multivariable logistic regression analysis examined the association between high preoperative anxiety and all-cause mortality/major morbidity, adjusting for the Society of Thoracic Surgeons predicted risk, age, gender, and depression symptoms. A total of 148 patients (mean age 75.8 ± 4.4 years; 34% women) completed the Hospital Anxiety and Depression Scale. High levels of preoperative anxiety were present in 7% of patients. No differences were found in the type of surgery and Society of Thoracic Surgeons predicted risk across the preoperative levels of anxiety. After adjusting for potential confounders, high preoperative anxiety was remained independently predictive of postoperative mortality or major morbidity (odds ratio 5.1, 95% confidence interval 1.3 to 20.2; p = 0.02). In conclusion, although high levels of anxiety were present in few patients anticipating cardiac surgery, this conferred a strong and independent heightened risk of mortality or major morbidity.

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