Patients who are divorced, separated or widowed had an approximately 40 percent greater chance of dying or developing a new functional disability in the first two years following cardiac surgery than their married peers, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania published in this week's JAMA Surgery.
"While it has been established that the chances of survival following major surgery may be better among married versus unmarried persons, it is not known how marriage 'marries' with actual postoperative function," said study co-author Mark Neuman, MD, MSCE, an assistant professor of Anesthesiology and Critical Care and a Senior Fellow at the Leonard Davis Institute for Health Economics at the Perelman School of Medicine at the University of Pennsylvania. "Understanding this may be useful for identifying patients who may be in need of additional support and targeted interventions aimed at improving functional recovery."
Neuman and study co-author, Rachel Werner, MD, PhD, an associate professor of General Internal Medicine and also a Senior Fellow at the Leonard Davis Institute of Health Economics, used a subset of data from the University of Michigan Health and Retirement Study, a database of 29,053 adults age 50 years and older in which study participants have undergone interviews every two years since 1998 about their health, functioning, medical care, and family structure.
For this study, the team analyzed data from the 2004, 2006, 2008 and 2010 interviews and included the 1,576 subjects who reported undergoing cardiac surgery in the interval since the preceding interview and deceased participants for whom a representative reported a cardiac surgery since the last interview. They collected demographic information including marital status, age, sex and comorbidities at enrollment and in the last interview before surgery. In addition, they collected information on preoperative dependence in six activities of daily living: dressing, movement ability, bathing, eating, toileting and getting in and out of bed.
They found that at the time of baseline interview, 65 percent were married 12 percent were divorced or separated, 21 percent were widowed and two percent were never married. At their post-surgery interview, 19 percent of the married participants, 29 percent of the divorced or separated subjects, 39 percent of the widowed and 20 percent of those who had never been married had either died or developed a new disability.
Compared with subjects who were married at baseline, the odds for death or a new functional disability during the first two years following cardiac surgery were 40 percent greater among those who are divorced, separated or widowed, the researchers found.
Neuman and Werner surmise that this may related to the social supports in influencing patients' choice of hospitals and their self-care. These findings also extend prior research suggesting postoperative survival advantages for married people, but further researcher is needed to understand and define the mechanisms that link marital status and postoperative outcomes.
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