โมเดลความสัมพันธ์เชิงสาเหตุที่มีต่อภาวะสุขภาพของผู้ป่วยภายหลังได้รับการผ่าตัดทำทางเบี่ยงหลอดเลือดหัวใจ

Teepatad Chintapanyakun; Suchart Chaiyaroj

Authors

Teepatad Chintapanyakun Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
Suchart Chaiyaroj Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok

Keywords:

coronary artery bypass graft surgery, health status, MIMIC Model Analysis

Abstract

The purpose of this research aimed to explore the causal relationship affecting health status among patients undergoing coronary artery bypass graft surgery (CABG). The participants were 310 patients who received CABG and visited physicians in the cardiac surgery clinics, both general and premium, at Ramathibodi Hospital. The instruments for data collection were questionnaires including comorbidity, knowledge of the disease and operation, self-care behaviors, and health conditions. The content validity was rated by experts and the internal consistency reliabilities for each questionnaire equaled .93, .87, .79, and .85, respectively. Descriptive statistics and the causal relationship model were analyzed by using the Mplus program.

The results showed that patients undergoing CABG had a good level of health status. Applying transition theory, the causal relationship model of health status outcomes among patients undergoing CABG was consistent with empirical data ( $gif.latex?\chi$ ² (df= 58, N = 310) = 97.588, p = .0009, $gif.latex?\chi$ ²/df = 1.68, CFI = .985, TLI = .981, RMSEA = .047, SRMR = .042). The factors in the model could together explain the variances of health status among patients undergoing CABG up to 81.60 percent. Age, comorbidity, and the level of cardiac function before surgery demonstrated a negatively direct effect on health status. In addition, left ventricular ejection fraction, knowledge of the disease and operation, and self-care behavior showed a positively direct effect on health status.

The findings of this study provided essential fundamental information for nurses to enhance knowledge and change self-care behavior among patients undergoing CABG. Furthermore, developing nursing interventions or protocols should prioritize patient-centered care before, during, and after surgery to optimize postoperative care and health outcomes.

Downloads

Download data is not yet available.

References

Abah, U., Dunne, M., Cook, A., Hoole, S., Brayne, C., Vale, L., & Large, S. (2015). Does quality of life improve in octogenarians following cardiac surgery? A systematic review. BMJ open, 5(4), e006904.

Abu-Omar, Y. & Taggart, D. P. (2014). Coronary artery bypass surgery. Medicine, 42(9), 527-531.

Charlson, M. E., Pompei, P., Ales, K. L., & Mackenzie, C. R. (1987). A new method of classifying prognostic co-morbidity in longitudinal studies: Development and validation. Journal of Chronic Disability, 40(5), 373-383.

Chintapanyakun, T., Ua-Kit, N., & Chaiyaroj, S. (2017). Predicting factors of health status among patients after coronary artery bypass graft surgery. Thai Journal of Cardio-Thoracic Nursing, 28(1), 96-110.

Gjeilo, K. H., Stenseth, R., Wahba, A., Lydersen, S., & Klepstad, P. (2018). Long-term health-related quality of life and survival after cardiac surgery: A prospective study. The Journal of thoracic and cardiovascular surgery, 156(6), 2183–2190.

Greenberg, J. W., Lancaster, T. S., Schuessler, R. B., & Melby, S. J. (2017). Postoperative atrial fibrillation following cardiac surgery: A persistent complication. European Journal of Cardio-Thoracic Surgery, 52(4), 665–672.

Hair, Jr. J.F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). New Jersey, NJ: Pearson Prentice Hall.

Hardin, S. R. & Kaplow, R. (2016). Cardiac surgery essentials for critical care nursing (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

Head, S. J., Börgermann, J., Osnabrugge, R. L., Kieser, T. M., Falk, V., Taggart, D. P., . . . Kappetein, A. P. (2013). Coronary artery bypass grafting: Part 2-optimizing outcomes and future prospects. European heart journal, 34(37), 2873–2886.

Head, S. J., Kieser, T. M., Falk, V., Huysmans, H. A., & Kappetein, A. P. (2013). Coronary artery bypass grafting: Part 1-the evolution over the first 50 years. European heart journal, 34(37), 2862–2872.

Hillis, L. D., Smith, P. K., Anderson, J. L., Bittl, J. A., Bridges, C. R., Byrne, J. G., . . . Winniford, M. D. (2011). 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. Circulation, 124(23), 2610–2642.

Kline, R. B. (2016). Principle and practice of structural equation modeling (4th ed.). New York, NY: Guilford Press.

Kurfirst, V., Mokráček, A., Krupauerová, M., Canádyová, J., Bulava, A., Pešl, L., & Adámková, V. (2014). Health-related quality of life after cardiac surgery-the effects of age, preoperative conditions and postoperative complications. Journal of Cardiothoracic Surgery, 9, 46.

Leurmarnkul, W., & Meetam, P. (2005). Properties testing of the retranslated SF-36 (Thai version). Thai Journal of Pharmaceutical Sciences, 29(1-2), 69-88.

McDonald, B., van Walraven, C., & McIsaac, D. I. (2020). Predicting 1-year mortality after cardiac surgery complicated by prolonged critical illness: Derivation and validation of a population-based risk model. Journal of Cardiothoracic and Vascular Anesthesia, 34(10), 2628–2637.

Meleis, A.I. (2010). Transitions theory: Middle-range and situation-specific theories in nursing research and practice. New York, NY: Springer.

Peric, V., Jovanovic-Markovic, S., Peric, D., Rasic, D., Novakovic, T., Dejanovic, B., & Borzanovic, M. (2015). Quality of life in patients of different age groups before and after coronary artery bypass surgery. Annals of Thoracic and Cardiovascular Surgery, 21(5), 474–480.

Powell, R., Scott, N. W., Manyande, A., Bruce, J., Vögele, C., Byrne-Davis, L. M., . . . Johnston, M. (2016). Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. The Cochrane Database of Systematic Reviews, 5, CD008646.

Rumsfeld, J. S. (2002). Health status and clinical practice: When will they meet? Circulation, 106(1), 5-7.

Schulz, P., Lottman, D. J., Barkmeier, T. L., Zimmerman, L., Barnason, S., & Hertzog, M. (2011). Medications and associated symptoms/ problems after coronary artery bypass surgery. Heart Lung, 40(2), 130-138.

Stephens, R. S., & Whitman, G. J. (2015). Postoperative critical care of the adult cardiac surgical patient: Part I: Routine postoperative care. Critical Care Medicine, 43(7), 1477–1497.

Stephens, R. S., & Whitman, G. J. (2015). Postoperative critical care of the adult cardiac surgical patient: Part II: Procedure-specific considerations, management of complications, and quality improvement. Critical Care Medicine, 43(9), 1995–2014.

Urtritaprasit, K. (2001). The relationship between recovery symptom and functional outcome in Thai CABG patients. Ohaio: Case Western Reserve University.

Ware, J. E. (2000). SF-36 health survey update. Spine, 25(24), 3130-3139.

Ware, J. E., Kosinski, M., & Dewey, J. E. (2003). Version 2 of the SF-36® Health Survey. Lincoln: Quality Metric Incorporated.