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Self-Reported Quality of Life and 30-Day Mortality in Elective Cardiac Surgery
Lieke van Susante1, Yuri Ganushchak1, Elham Bidar2
1Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands.
Background:
Health-related quality of life (HRQoL) is increasingly assessed in cardiac surgery research, yet its association with hard clinical endpoints, such as mortality, remains underexplored. Demonstrating such an association may support HRQoL use in preoperative risk assessment.
Objectives:
The purpose of this study was to evaluate the association between preoperative self-reported HRQoL (Short-Form Health Survey) and 30-day mortality in patients undergoing elective cardiac surgery.
Methods:
This retrospective cohort study analyzed prospectively collected data from adults undergoing cardiac surgery at Maastricht University Medical Center (2018-2023). Preoperative Short-Form Health Survey T-scores were used in a 2-step cluster analysis to identify higher and lower HRQoL groups. Thirty-day mortality and composite morbidity were compared between clusters. Physical (Physical Component Summary) and mental (Mental Component Summary) scores were analyzed in multivariable Cox models, with effects expressed per 10-point increase.
Results:
Among 2,259 patients, 55 (2.43%) died within 30 days. Mortality was lower in the higher HRQoL group (1.38% vs 3.71%; P < 0.001). Lower HRQoL was independently associated with higher mortality (adjusted HR: 2.22; 95% CI: 1.23-4.02; P = 0.008). Composite morbidity occurred less often in the higher HRQoL group (8.5% vs 11.4%; P = 0.026). Among patients with complications, mortality was lower in the higher HRQoL group (11.8% vs 23.0%; P = 0.031). Higher Physical Component Summary, but not Mental Component Summary, was associated with lower mortality (HR per 10-point increase 0.66; 95% CI: 0.49-0.91; P = 0.01).
Conclusions:
Lower preoperative HRQoL was independently associated with higher 30-day mortality following elective cardiac surgery. Increased mortality following complications in patients with lower HRQoL suggests limited physiological reserve. Incorporating HRQoL, particularly physical health, may improve preoperative risk stratification.
