12 – A COMPARISON OF FUNCTIONAL OUTCOMES BETWEEN ELECTIVE CORONARY ARTERY BYPASS GRAFT SURGERY AND ELECTIVE LOWER EXTREMITY JOINT REPLACEMENT SURGERY

Abstract

Purpose: Deciding how to allocate scarce surgical resources is a worldwide issue. These decisions can be especially difficult when considering procedures aimed primarily at improving functional quality of life, such as lower extremity joint replacement (LEJR) surgery, and those procedures that can be perceived primarily as life preserving but should also have an impact on physical function, such as coronary artery bypass graft (CABG) surgery. A comparison of the functional outcomes of these two different procedures may provide further evidence to guide resource allocation decisions. The purpose of this study is to compare patient-reported functional outcomes following CABG and LEJR surgery using standardized, validated outcome metrics.

Method: A retrospective review of prospectively collected pre and post-operative health related quality of life (SF-36) measures from patients undergoing elective CABG and elective LEJR surgery in an academic surgical center. The sample included 112 CABG patients who were matched with LEJR patients based on gender and age.

Results: The mean age in the CABG group was 63 years, in the LEJR group 64 years. Seventy eight percent (78%) of the patients were male. Pre-operatively, CABG patients reported statistically higher (p< 0.05) Physical Functioning, less Bodily Pain, and superior Physical Component summary SF-36 scores compared to the LEJR group. However, their pre-operative General Health scores were statistically lower. Surgery resulted in a general improvement in all SF-36 scales and summary scores for all patients, with statistically significant improvements in Bodily Pain and General Health Scores occurring in both groups. Interestingly, the improvement in Bodily Pain score was greater for the LEJR group than the CABG group, whereas the improvement in General Health Score was greater in the CABG group. However the pre-operative pattern of statistically better Physical Functioning, Bodily Pain and Physical Component summary SF-36 scores in the CABG group, and superior General Health scores in the LEJR group remained following surgery.

Conclusion: It appears that, despite being matched for age and gender, significant pre-operative general health differences exist between CABG and LEJR patients that persist post-operatively. While surgery does result in significant improvements for both groups, CABG patients enjoy greater improvement in General Health scores while LEJR patients benefit from greater improvements in Bodily Pain scores. Further research is currently underway to examine how these differences are reflected in disease-specific scores and in health care resource utilization.