Psychological Factors and Recovery From Cardiac Surgery

21 Subjects awaiting open-heart surgery were given personality and attitude questionnaires. They were re-tested six months after the operation, when they were divided into "completely recovered" (I) and "not completely recovered" (II) groups, according to the New York Heart Association classification. Results showed that Group I was significantly less depressed, more optimistic about the future and had a more positive attitude towards others. Group II realised they had been very ill and had a more negative attitude towards their spouses. Group I was found to be much better adjusted, vocationally and psychosexually, than Group II. Since the advent of cardiac surgery in the 1950s, there has been concern over psychiatric disturbances that may develop after otherwise successful heart operations. 1-3 The incidence of psychological disturbances after routine surgery has been reported to be about 1 in 1, 500. 4 In 1965, a series of separate studies on the frequency of delirium after open-heart surgery showed that it occurred in 38% to 70% of the cases. 5-7 Recent studies indicate a reduced frequency 10% - 45%. 8-13 An operation which is technically successful is not invariably followed by the anticipated relief of all symptoms. Emotional factors like depression, anxiety, and the patient's attitude are closely related to the rate of recovery from open-heart surgery. 15 Knox 16 has noted that overall physical and psychological adjustment following surgery was closely related to the pre piorbid personality pattern and psychological adjustment. Relatively limited information is available however, about psychological functioning following open-heart surgery. Blachly and Blachly, 17 in their questionnaire survey of 263 patients, noted a substantial incidence of voca tional and emotional morbidity after operation. Burgess et al. 18 in their questionnaire study of 203 patients, showed a 27% incidence of 'bad' psychological outcome. Kimball, 19 in his study of 90 open-heart surgery patients, traced their long-term life adjustment; he divided the patients into four categories, based on psychiatric interview — "Adjusted" patients had realistic adaptation to their illness and surgery, "Symbiotic" patients derived considerable gain from their symptoms and had a poor long-term response, an "Anxious" group, who denied anxiety, but could not control it, had 25 % surgical morbidity and a variable long-term response, while the "Depressed" group had the highest death rate (78%). Morgan, 20 in his study of 72 patients, has suggested that those who were over-anxious pre-operatively were more prone to bouts of depression post-operatively. Heller, 21 in his follow up study of 142 patients one year after open-heart surgery, found that 38% experienced moderate to severe psychological hindrances to optimal recovery. These hindrances were more strongly associated with pre-operative maladjustment than with either cardiac status or post-operative life stress, and these patients could be called 'high risk'. At one-year follow-up, patients in the "high risk" group were found to be maladjusted, and they showed high levels of anxiety, depres sion, and somatic pre-occupation. Coates et al, 22 investigating job status after open-heart surgery on 101 patients in 1952-1955, found that 81% had returned to work. Goldberg and Spector 23 found that 83% were back at work, but do not give details of the type of surgery in volved. Blachly and Blachly found that 41% of their sample felt unable to work.