First author name | Year | Country | Primary or secondary aim | Sample (N=number of patients in analysis/eligible patients, Nt(i)=sample size per time point, Nc=patients with complications, N1=cases vs N2=controls) | Patient inclusion criteria | Study design | Type of surgery | Surgical complications/method of recording | Psychosocial outcome/time points/measurement tool | Significant association of complications with well-being (yes/no/confounding) | Types of complications and time points of significant effects | Quality assessment score (out of 8) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Deaton | 2009 | USA | Secondary | Nt1=317/442 Nt2=270 Nc=44% (130) | Patients with documented T2DM undergoing CABG | Observational, cohort, prospective | CABG | Infection of the leg, thorax, sternum, bloodstream or urinary tract; central neurological deficit (stroke or transient ischemia, coma); pneumonia, pulmonary insufficiency with prolonged ventilation or reintubation, pulmonary embolism; renal failure; arrhythmias requiring treatment; prolonged inotropic support or use of intra-aortic balloon pump; or reoperation for bleeding or tamponade/patient records | QoL/3 months post-op/SF-36 | Yes | Any complications/3 months postsurgery | 6 |
El Baz | 2008 | The Netherlands | Secondary | Nt1=198/256 Nt2=168 Nc=? | Consecutive patients who were scheduled for CABG following a coronary angiography | Observational, cohort, prospective | CABG | Postoperative events such as use of inotropes, atrial arrhythmias, or ventricular arrhythmias, sternal resuturing, re-exploration for bleeding, and time spent on mechanical ventilation/registry database, medical notes, outpatient notes and intensive therapy unit charts | QoL/preoperative and 6 months postoperative/SF-36 | Yes* | Re-exploration for bleeding and sternal resuturing/6 months postsurgery | 8 |
Ferguson | 2009 | USA | Primary | N=124/221 Nc=22 | Prospective patients who underwent major lung resection for early stage lung cancer. | Observational, cross-sectional | Major lung resection for early stage lung cancer (lobectomy, bilobectomy, pneumonectomy) | Complications were categorised as pulmonary (pneumonia, prolonged intubation, reintubation, air leak more than 7 days, lobar collapse requiring intervention), cardiovascular (pulmonary embolism, myocardial infarction, new postoperative arrhythmia, need for intravenous inotropic agents), other, and any complication/administrative database, hospital medical records, office shadow files | QoL/average of 2.6 years postoperative (3 months to 6.4 years)/EORTC QLQ-C30, EORTC QLQLC13 and DASS-21 | Yes | Pulmonary complications/2.6 years postsurgery (range 3 months to 6.4 years) | 6 |
Gjeilo | 2010 | Norway | Primary | Nt1=534/631 Nt2=462 Nt3=465 Nc(t2)=52 | Patients undergoing cardiac surgery | Observational, cohort, prospective | Midline sternotomy | Chronic pain (pain arising after surgery and persisting either continuously or intermittently for 3 months or more/BPI | QoL/preoperative, 6 and 12 months postoperative/SF-36 | Yes* | Chronic postsurgical pain/12 months postsurgery | 6 |
Hata | 2006 | Japan | Secondary | N=452/452 Nc=? | Consecutive adult patients who underwent open heart surgery | Observational, cross-sectional | CABG | Postoperative morbidity (minor stroke, infection, pneumonia, haemodialysis, paraplesis)/patient records | Depression/5–7 days postopertive/interviewed by a psychiatrist and CES-D | Confounding | Postoperative minor stroke and pneumonia/5–7 days postsurgery | 6 |
Jarvinen | 2004 | Finland | Primary | Nt1=501/1128 Nt2=485 Nc=80 | Patients who underwent CABG | Observational, cohort, prospective | CABG (89% via sternotomy incision with cardiopulmonary bypass (CPB; on-pump) and 11% without CPB (off-pump)) | Perioperative myocardial infarctions/clinical examination + clinical tests (ECGs, echocardiography, laboratory tests) | QoL/preoperative and 12 months postoperative/RAND-36 | Yes* | Perioperative myocardial infarctions /12 months postsurgery | 7 |
Jideus | 2009 | Sweden | Primary | N1=73/84 (cases) N2=42/? (controls) |
| Observational, case–control, cross-sectional | Cardiopulmonary bypass | SWIs: deep infection involving retrosternal tissue and/or the sternal bone)/clinical examination | QoL/20 months postoperative (range 7–40)/SF-36 | Yes* | Serious wound infections/20 (range 7–40) months postsurgery | 4 |
Kinney | 2012 | USA | Primary | N=99 Nt1=120/? Nt2=99 Nc=75 | Patients aged 45–75 years undergoing elective thoracotomy | Observational, cohort, prospective | Serratus-sparing posterolateral thoracotomy or limited thoracotomy | Chronic post-thoracotomy pain/Leeds Assessment of Neuropathic Symptoms and Signs + self-reports | QoL/preoperative, 3 months postoperative/SF-36 | Yes* | Chronic post-thoracotomy pain/3 months postsurgery | 7 |
Landoni | 2006 | Italy | Primary | N1=22/42 (cases) N2=40/42 (controls) | Cases: patients who underwent cardiac surgery and developed ARF requiring RRT and left the hospital aliveControls: matched controls who did not develop ARF and did not receive RRT | Observational, case–control, cross-sectional | Cardiac surgery (procedures not specified) | ARF requiring RRT/administrative database, registry | QoL/23–42 months post-op/SF-36 | No | NA | 6 |
Le Grande | 2006 | Australia | Secondary | Nt1=182/444 Nt2=128 Nt3=114 Nc=? | Adults on the waiting list for CABG | Observational, cohort, prospective | CABG | Postsurgical complications such as cardiac arrhythmias, stroke and infections/medical records | QoL/preoperative, 2 and 6 months postoperative/SF-36 | Yes* | New cardiac arrhythmia postsurgery, atrial fibrillation/6 months postsurgery | 7 |
Martin | 2008 | USA | Primary | Nt1=836/2,007 Nt2=2.007 Nc=189 | Patients undergoing elective open heart surgery | Observational, cohort, prospective | Open heart surgery (133 valve procedure; 620 CABG; 67 CABG plus valve procedure; 15 CABG plus other cardiac procedure; and 1 closure of an atrial septal defect) | Perioperative myocardial infarction, mediastinitis, superficial wound infection, septicaemia, permanent stroke, transient ischaemic attack, continuous coma, prolonged intubation, ventilator-associated pneumonia, cardiac tamponade, atrial fibrillation, reoperation for bleeding, renal failure, renal failure which required dialysis, and length of stay/method not specified | QoL/preopeative, 1 year postopeative/SF-20 | No* | NA | 6 |
Merkouris | 2009 | Greece | Secondary | Nt1=63/63 Nt2=59 Nt3=56 Nc=42 | All patients over 65 presenting a 1, 2 or 3 vessel disease treated with CABG without concurrent procedures (eg, valve replacement) | Observational, cohort, prospective | CABG | Retrospective list of complications: atrial fibrillation, re-exploration for bleeding, low cardiac output syndrome, acute respiratory failure, sternal wound infection, neurological dysfunction, mild problems related to leg incision healing or swelling, chest incision discomfort and medications/method not specified | QoL/preopeative, 4 and 12 months postopeative/MacNew Heart Disease HRQoL questionnaire | No* | NA | 5 |
Moller | 2012 | Sweden | Secondary | Nt1=249/? Nt2=213 Nc=? | Prospective patients scheduled for lung surgery for lung cancer | Observational, cohort, prospective | Lung surgery | Complication was defined as any of the following postoperative complications: new onset atrial fibrillation, prolonged air leak (chest tubes in place for more than 5 days), pneumonia, reintubation, reoperation, or hospital stay of 8 days or more/method not specified | QoL/preoperative, 6 months postoperative/SF-36 | Yes* | Any complications/6 months postsurgery | 6 |
Myles | 2001 and 2006 | Australia | Secondary | Nt1=120/125 Nt2=120 (days 1, 2, 3) Nt3=108 Nt4=94 Nc=69 | Adult cardiac surgical patients | Observational, cohort, prospective | Cardiac surgery (specific procedures not specified) |
| QoL/preoperative, 1 and 3 months, 3 years postoperative/SF-36 | Confounding* | Any complications/3 months postsurgery | 8 |
Peric | 2008 | Serbia and Montenegro | Secondary | Nt1=208/? Nt2=192 Nc=60 | Consecutive patients who underwent elective CABG | Observational, cohort, prospective | CABG | Retrospective list of complications: low cardiac output (cardiac index lower than 2 L/min/m2), mechanical ventilation longer than 24 h, reoperation for bleeding, sternal wound infection, perioperative myocardial infarction, pericardial effusion, arrhythmic complications (atrial fibrillation, ventricular tachycardia, ventricular fibrillation), abdominal complications, and other/observations, ECGs, echocardiography, laboratory tests | QoL/preoperative, 6 months postoperative/NHP Questionnaire | Yes* | Any complications/6 months postsurgery | 7 |
Rodriguez | 2008 | USA | Secondary | Nt1=397/? Nt2=? Nt3=? Nt4=? Nc=23 | Patients diagnosed with upper extremity hyperhidrosis (HH) treated with thoracic sympathectomy (TS) | Observational, cohort, prospective | Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis |
| QoL/preoperative, discharge, 6 and 12 months postoperative/SF-36 | No* | NA | 3 |
Tully | 2011 | Australia | Primary | Nt1=226/238 Nt2=222 Nc=56 | Patients undergoing first-time CABG surgery | Observational, cohort, prospective | CABG | New-onset AF between the patient's day of admission to the intensive care unit and the median day of discharge (day 5) after CABG during the index hospitalisation/ECGs, transthoracic echocardiographs reviewed by technicians and reviewers blinded to patients’ psychological distress scores | Anxiety, depression, stress/preoperative (mean=2 days, SD=2 days) and postoperative (mean=6 days, SD=2 days)/ DASS | Yes* | Atrial fibrillation/6 days (SD=2 days) postsurgery | 7 |
*Study controlled for patients’ preoperative well-being.
ARF, acute renal failure; AF, atrial fibrillation; BPI, Brief Pain Inventory; CES-D, Center for Epidemiological Studies Depression Scale; CS, compensatory sweating; DASS, Depression Anxiety Stress Scales; DASS, Short version of the Depression Anxiety Stress Scales; EORTC QLQLC, European Organisation for Research and Treatment of Cancer core Lung Cancer Questionnaire; HRQoL, health-related quality of life; NA, not available; NHP, Nottingham Health Profile; QoL, quality of life; RRT, renal replacement therapy; SF, Short Form Health Survey; SWI, sternal wound infection; T2DM, type 2 diabetes mellitus.