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PLoS One. 2019 Feb 28;14(2):e0213324. doi: 10.1371/journal.pone.0213324. eCollection 2019.

Impact of preoperative physical activity and depressive symptoms on post-cardiac surgical outcomes.

Author information

1
Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
2
Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada.
3
Section of Cardiac Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
4
Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
5
St. Boniface General Hospital, Cardiac Psychology Service, Winnipeg, Manitoba, Canada.

Abstract

OBJECTIVE:

To determine the independent and combined impact of preoperative physical activity and depressive symptoms with hospital length of stay (HLOS), and postoperative re-hospitalization and mortality in cardiac surgery patients.

METHODS:

A cohort study including 405 elective and in-house urgent cardiac surgery patients were analyzed preoperatively. Physical activity was assessed with the International Physical Activity Questionnaire to categorize patients as active and inactive. The Patient Health Questionnaire-9 was used to evaluate preoperative depressive symptoms and categorize patients as depressed and not depressed. Patients were separated into four groups: 1) Not depressed/active (n = 209), 2) Depressed/active (n = 48), 3) Not depressed/inactive (n = 101), and 4) Depressed/inactive (n = 47). Administrative data captured re-hospitalization and mortality data, and were combined into a composite endpoint. Models adjusted for demographics, comorbidities, and cardiac surgery type. Multiple imputation was used to impute missing values.

RESULTS:

Preoperative physical activity behavior and depression were not associated with HLOS examined in isolation or when analyzed by the physical activity/depressive symptom groups. Physical inactivity (HR: 1.60, 95% CI 1.05 to 2.42; p = 0.03), but not depressive symptoms, was independently associated with the composite outcome. Freedom from the composite outcome were 76.1%, 87.5%, 68.0%, and 61.7% in the Not depressed/active, Depressed/active, Not depressed/inactive, and Depressed/inactive groups, respectively (P = 0.02). The Active/Depressed group had a lower risk of the composite outcome (HR: 0.35 95% CI 0.14 to 0.89; p = 0.03) compared to the other physical activity/depression groups.

CONCLUSION:

Preoperative physical activity appears to be more important than depressive symptoms on short-term postoperative re-hospitalization and mortality.

Conflict of interest statement

This work was supported by an unrestricted education grant from Pfizer Canada Inc [no grant number]. This grant is held by Rakesh C Arora. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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