Soc. S~i. & Med.. VoL 13A. pp. 457 to 461 Pergamon Press Ltd 1979. Printed in Great Britain QUALITY OF LIFE AND CORONARY ARTERY BYPASS SURGERY PATIENTS* WALTER F. LAMENDOLA and RONALD V. PELLEGRIN1 Three Rivers Cardiac Institute, Mercy Hospital, Pittsburgh Abstract--A sample of 95 coronary artery bypass surgery (CABS) patients was studied in order to examine the relationship between quality of life and CABS. Quality of life is studied through measures of social situation, physical limits, and work status. Findings indicate that quality of life improvement is a function of the patient's post-operative experience and perception of their physical limits, which, in turn, is likely to influence their desire to work. Retirement rates are high, particularly among patients over 55 years of age. Unemployment rates are high among those patients between 49-54 years of age. However, surprisingly few patients saw themselves as physically limited, a reflection of the high overall satisfaction with surgical outcome. The discussion focuses upon the use of productivity rather than work status measures as indicators of CABS success. The importance of the affiliative experience leads to specification of conditions under which life quality can be improved as a result of CABS. Surgery is discussed as a part of a complex interplay of physical and social experiences which influence individual and social benefits. Improvement in the patient's quality of life is a pri- mary concern of physicians and patients in regard to the surgical outcomes of coronary artery bypass surgery (CABS). Yet there is little evidence concerning the quality of life benefits of CABS despite its increas- ingly widespread use to combat this country's most serious disease [1, 2]. The elimination of pain and restoration of function CABS can provide recommend it, while expense has been termed a disadvantage ($12,500 average cost per operation in 1977)[3,4]. Long term studies in regard to the association of CABS and longevity need time in order to produce meaningful interpretations of results [5]. The same is true of comparative studies which contrast medical and surgical disease treatment [6]. Because these studies may return results which do not clearly justify CABS in traditional terms, quality of life improve- ment becomes more at issue. No major studies have been mounted which examine the conditions under which life quality can be improved as a result of CABS. There has been critical comment concerning the relationship between CABS and improvement in the quality of a patient's life [7, 8]. At worst, CABS is viewed as a technological dinosaur. At best, it rep- resents an essence distilled from human skill, tech- nology, and medical science. Considerations of qua- lity of life challenge medical thinking, much as they have challenged other professions. Quality of life mixes what may be more traditional measures, such as longevity, with subjective assessments and social policy goals. It is a concept which can bridge indivi- dual and social considerations. In the case of CABS, quality of life poses vital, unresolved issues. Is the expense of resources warranted by patient benefits? Are patient benefits overshadowed by social disad- vantages of cost, exclusiveness, and resource con- sumption? In order to respond to these questions, * Funds in support of this study were provided by Three Rivers Cardiac Institute. The authors wish to thank Mercy Hospital for their cooperation in the conduct of this study. this study examines the content, type, and variation of patient quality of life benefits. Quality of life is a complex value concept that the individual uses to subjectively assess the desirability of a particular way of life. The quality of that way of life is available through the satisfaction it provides the individual [9]. Yet the achievement of a reason- able quality of life for CABS patients depends not only upon their medical management, but also upon the management of their social situation [10]. In addition, a major concern of CABS patients is the degree to which their illness has imposed physical limits upon them. Therefore, for purposes of this study, quality of life is defined as the individual's achievement of a satisfactory social situation within the limits of perceived physical capacity. A social situation is one in which we interact with others. Through such encounters, we reduce our fear and anxiety, and we fulfil our need to affiliate. The social situation provides the occasion for the CABS patient to construct a vision of the way of life to which they can aspire [11]. Patients evaluate how they are doing by cues from family, physicians and others [12-16-1. The patient's assessment of health is greatly influenced in either direction by those around him and those with whom the patient compares him- self. The importance of the social situation is under- lined by findings that desired patient responses may be more readily accomplished if accompanied by a high degree of familial support [17]. There has been heart research directed toward de- veloping an understanding of the social situation [18-22]. Frank's survey of Mended Heart members provides insight into a range of situational factors, such as family relations and job performance, attect- ing persons who have undergone a variety of cardio- vascular surgical procedures [23]. Croog, Levine, and Lurie examined the direction of heart research and noted a lack of information concerning situational processes [24]. Such a point of view is later amplified by Granger who describes undesirable emotional reactions to the social situation, such as somatic 457 S,S.M. i 3/4A--F