Table 2

Key characteristics of cardio-thoracic surgery studies (n=17)

First author nameYearCountryPrimary or secondary aimSample (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 criteriaStudy designType of surgerySurgical complications/method of recordingPsychosocial outcome/time points/measurement toolSignificant association of complications with well-being (yes/no/confounding)Types of complications and time points of significant effectsQuality assessment score (out of 8)
Deaton2009USASecondaryNt1=317/442
Nt2=270
Nc=44% (130)
Patients with documented T2DM undergoing CABGObservational, cohort, prospectiveCABGInfection 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 recordsQoL/3 months post-op/SF-36YesAny complications/3 months postsurgery6
El Baz2008The NetherlandsSecondaryNt1=198/256
Nt2=168
Nc=?
Consecutive patients who were scheduled for CABG following a coronary angiographyObservational, cohort, prospectiveCABGPostoperative 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 chartsQoL/preoperative and 6 months postoperative/SF-36Yes*Re-exploration for bleeding and sternal resuturing/6 months postsurgery8
Ferguson2009USAPrimaryN=124/221
Nc=22
Prospective patients who underwent major lung resection for early stage lung cancer.Observational, cross-sectionalMajor 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 filesQoL/average of 2.6 years postoperative (3 months to 6.4 years)/EORTC QLQ-C30, EORTC QLQLC13 and DASS-21YesPulmonary complications/2.6 years postsurgery (range 3 months to 6.4 years)6
Gjeilo2010NorwayPrimaryNt1=534/631
Nt2=462
Nt3=465
Nc(t2)=52
Patients undergoing cardiac surgeryObservational, cohort, prospectiveMidline
sternotomy
Chronic pain (pain arising after surgery and persisting either continuously or intermittently for 3 months or more/BPIQoL/preoperative, 6 and 12 months postoperative/SF-36Yes*Chronic postsurgical pain/12 months postsurgery6
Hata2006JapanSecondaryN=452/452
Nc=?
Consecutive adult patients who underwent open heart surgeryObservational, cross-sectionalCABGPostoperative morbidity (minor stroke, infection, pneumonia, haemodialysis, paraplesis)/patient recordsDepression/5–7 days postopertive/interviewed by a psychiatrist and CES-DConfoundingPostoperative minor stroke and pneumonia/5–7 days postsurgery6
Jarvinen2004FinlandPrimaryNt1=501/1128
Nt2=485
Nc=80
Patients who underwent CABGObservational, cohort, prospectiveCABG (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-36Yes*Perioperative myocardial infarctions /12 months postsurgery7
Jideus2009SwedenPrimaryN1=73/84 (cases)
N2=42/? (controls)
  • Cases: patients who developed SWI after cardiopulmonary bypass

  • Controls: patients prior to CABG and evaluated 1 year postoperative and matched for time of the operation, age and sex

Observational, case–control, cross-sectionalCardiopulmonary bypassSWIs: deep infection involving retrosternal tissue and/or the sternal bone)/clinical examinationQoL/20 months postoperative (range 7–40)/SF-36Yes*Serious wound infections/20 (range 7–40) months postsurgery4
Kinney2012USAPrimaryN=99
Nt1=120/?
Nt2=99
Nc=75
Patients aged 45–75 years undergoing elective thoracotomyObservational, cohort, prospectiveSerratus-sparing
posterolateral thoracotomy or limited thoracotomy
Chronic post-thoracotomy pain/Leeds Assessment of Neuropathic Symptoms and Signs + self-reportsQoL/preoperative, 3 months postoperative/SF-36Yes*Chronic post-thoracotomy pain/3 months postsurgery7
 Landoni2006ItalyPrimaryN1=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 RRTObservational, case–control, cross-sectionalCardiac surgery (procedures not specified)ARF requiring RRT/administrative database, registryQoL/23–42 months post-op/SF-36NoNA6
Le Grande2006AustraliaSecondaryNt1=182/444
Nt2=128
Nt3=114
Nc=?
Adults on the waiting list for CABGObservational, cohort, prospectiveCABGPostsurgical complications such as cardiac arrhythmias, stroke and infections/medical recordsQoL/preoperative, 2 and 6 months postoperative/SF-36Yes*New cardiac arrhythmia postsurgery, atrial fibrillation/6 months postsurgery7
Martin2008USAPrimaryNt1=836/2,007
Nt2=2.007
Nc=189
Patients undergoing elective open heart surgeryObservational, cohort, prospectiveOpen 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 specifiedQoL/preopeative, 1 year postopeative/SF-20No*NA6
Merkouris2009GreeceSecondaryNt1=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, prospectiveCABGRetrospective 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 specifiedQoL/preopeative, 4 and 12 months postopeative/MacNew Heart Disease HRQoL questionnaireNo*NA5
Moller2012SwedenSecondaryNt1=249/?
Nt2=213
Nc=?
Prospective patients scheduled for lung surgery for lung cancerObservational, cohort, prospectiveLung surgeryComplication 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 specifiedQoL/preoperative, 6 months postoperative/SF-36Yes*Any complications/6 months postsurgery6
Myles2001 and 2006AustraliaSecondaryNt1=120/125
Nt2=120 (days 1, 2, 3)
Nt3=108
Nt4=94
Nc=69
Adult cardiac surgical patientsObservational, cohort, prospectiveCardiac surgery (specific procedures not specified)
  1. Respiratory: postoperative mechanical ventilation for more than 24 h or pneumonia, defined as pulmonary infiltrate with positive microbial cultures

  2. Cardiac: arrhythmia requiring treatment with antiarrhythmic medication or electrical cardioversion reversion; radiological evidence of pulmonary oedema; or myocardial infarction, defined by new Q waves on ECG or creatine kinase-MB isoenzyme concentration greater than twice normal

  3. Renal: acute renal failure, defined by serum creatinine concentration greater than 200 M

  4. Neurological: stroke, defined as a new central neurological deficit

  5. Sepsis: wound infection requiring excision of tissue or antibiotic therapy, or positive microbial culture (other than pneumonia)

    • Clinical and laboratory tests (microbial cultures, radiological data, ECGs, etc)

QoL/preoperative, 1 and 3 months, 3 years postoperative/SF-36Confounding*Any complications/3 months postsurgery8
Peric2008Serbia and MontenegroSecondaryNt1=208/?
Nt2=192
Nc=60
Consecutive patients who underwent elective CABGObservational, cohort, prospectiveCABGRetrospective 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 testsQoL/preoperative, 6 months postoperative/NHP QuestionnaireYes*Any complications/6 months postsurgery7
Rodriguez2008USASecondaryNt1=397/?
Nt2=?
Nt3=?
Nt4=?
Nc=23
Patients diagnosed with upper extremity hyperhidrosis (HH) treated with thoracic sympathectomy (TS)Observational, cohort, prospectiveThoracoscopic sympathectomy for palmar and axillary hyperhidrosis
  • CS: excessive sweating considered abnormal in other parts of the body after TS

  • Gustatory sweating: facial sweating after eating foods

  • Excessive dryness: dryness affecting the hands and requiring hydration

  • Method not specified

QoL/preoperative, discharge, 6 and 12 months postoperative/SF-36No*NA3
Tully2011AustraliaPrimaryNt1=226/238
Nt2=222
Nc=56
Patients undergoing first-time CABG surgeryObservational, cohort, prospectiveCABGNew-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 scoresAnxiety, depression, stress/preoperative (mean=2 days, SD=2 days) and postoperative (mean=6 days, SD=2 days)/ DASSYes*Atrial fibrillation/6 days (SD=2 days) postsurgery7
  • *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.