Return to Work After Coronary Artery Bypass Surgery: Psychosocial and Economic Aspects

409 Pages·1985·8.284 MB·English

by  A. J. Anderson, J. J. Barboriak, R. G. Hoffmann, D. C. Mullen, J. A. Walker (auth.), Prof. Dr. Paul J. Walter (eds.)

Return to Work
After Coronary Artery
Bypass Surgery
Psychosocial and Economic Aspects
Editor: P. J. Walter
With 102 Figures and 204 Tables
Springer-Verlag
Berlin Heidelberg New York Tokyo
Prof. Dr. Paul J. Walter
Department of Cardiovascular Surgery
University Hospital Antwerp
Wilrijkstraat 10, B-2520 Antwerp-Edegem, Belgium
ISBN-13: 978-3-642-69857-6 e-ISBN-13: 978-3-642-69855-2
DOI: 10.1007/978-3-642-69855-2
Library of Congress Cataloging in Publication Data. Main entry under title:
Return to work after coronary artery bypass surgery. Proceedings of a sym
posium held at Herz-Kreislauf-Zentrum Rotenburg/Fulda, May 10-11,
1984. IncIudes bibliographies and index. 1. Aortocoronary bypass-Pa
tients-Rehabilitation. 2. Aortocoronary bypass-Patients-Employment. 3.
Aortocoronary bypass-Patients-Psychology. 4. Aortocoronary bypass
Costs. I. Walter, P. J. (Paul J.), 1935-. [DNLM: 1. Aortocoronary By
pass-rehabilitation-congresses. 2. Employment-congresses. 3. Rehabili
tation, Vocational-economics-congresses. 4. Rehabilitation, Vocational
psychology-congresses. WG 169 R439 1984]
RD598.R47 1985 617'.412 85-4620
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Preface
When I gave a presentation on return to work after heart valve
replacement at the Tenth Congress of the German Society for
Thoracic and Cardiovascular Surgery in 1981, I was surprised
by the relatively low level of interest that cardiac surgeons
seemed to have in this subject. This stimulated me to intensify
my research in this area and to extend it to patients with coron
ary heart disease.
Obviously, physiological and mechanical aspects of medical
treatment are of special interest to the surgeon. For the majority
of cardiac surgical patients, that is those with coronary heart
disease, the technical problems of the operative procedure have
been solved to a great extent. Many studies have demonstrated
that, aside from reduction of symptoms, aortocoronary bypass
operation can lead to improvement of cardiac performance un
der stress conditions. However in spite of the technical solutions
to hemodynamic problems, it has become very clear that the
reintegration of patients into their social sphere has not been
accomplished to the extent that might be expected, as exempli
fied by the relatively low rate of postoperative return to work.
Apparently, factors other than hemodynamics and cardiac func
tion impede resumption of the normal lifestyle, enjoyed before
the onset of the symptoms of angina pectoris. Return to work
after coronary bypass surgery must be seen in a larger psychoso
cial framework, to understand the deeper reasons for the low in
cidence. Factors such as the time spent on the waiting list, the
role of family and friends, the expectations of the spouse, moti
vation and guidance from the family doctor, the cardiologist and
other hospital staff, and the attitude of employer and colleagues
should be studied.
Research should embrace not only, bypass operation, but
also percutaneous transluminal coronary angioplasty and con
servative treatment.
The great number of coronary operations (ab out 170000 in
the USA in 1983) is a very large burden on the state's social re
sources. The overall cost to the state could be reduced if it were
possible to reintegrate a large number of these patients into
working life. The expense of the operation could be recovered
VI Preface
within a short time if return to work were increased (higher tax
revenue, lower pension and welfare payments).
This book presents the papers from an international sympo
sium which took pi ace on May 10-11, 1984, in the Herz- und
Kreislau/zentrum, Rotenburg, Federal Republic of Germany,
under the patronage of the International Society of Cardiovas
cular Surgery and the German Society of Thoracic and Cardio
vascular Surgery. The scientific committee consisted of
H. G. Borst, Hannover; W. D. Johnson, Milwaukee; F. Loogen,
Düsseldorf; G. Rodewald, Hamburg; A. Senning, Zürich; and
P. Walter, Antwerp.
For the financial support necessary for the symposium to be
held, I would like to thank Pharma Schwarz, Monheim, Federal
Republic of Germany, represented by Mr. GÜcker. I would like
to say a special word of thanks to Mrs. B. Kratzenberg for her
excellent organizational support. I am grateful to all the authors
for their cooperation, and to Springer-Verlag, represented by
Mr. B. Lewerich and his colleagues, for accurate and rapid pub
lication.
Paul J. Walter
Contents
Return to Work After Coronary Artery Bypass Surgery:
Incidence and Main Factors ................ 1
A. J. ANDERSON, J. J. BARBORIAK, R. G. HOFFMANN,
D. C. MULLEN, AND J. A. WALKER
Age- and Sex-Specific Incidence and Main Factors 3
H. H. BENTALL
Psychosocial and Economic Aspects 13
I. K. CROSBY, J. CHIANG, S. JORDAN, R. L. MENTZER JR.,
I. L. KRON, D. L. KAISER, AND G. B. CRADDOCK JR.
The Influence of Economic and Societal Factors 19
H. O. VETTER, H. HOFMANN, K. GLONNER, A. NEISS, B. REICHART,
AND W. KLINNER
Employment Status: Pre- and Postoperative Characteristics 30
R. W. HACKER, H. RIEDL, I. GUGGENMOOs-HoLZMANN,
AND M. TORKA
Employment Status of Patients After Coronary Artery
Bypass Surgery . . . . . . . . . . . . . . . . . . . . . 38
M. E. ROTHLIN, R. SIEBER, AND Ä. SENNING
Can Aortocoronary Bypass Surgery Improve Return
to Work? ....................... 46
M. WELSCH, G. BERGMANN, D. MAYER, H. C. MEHMEL,
W. SAGGAU, AND W. SCHMITZ
Factors Contributing to Resumption of Work 50
A. OBERMAN
Summary of the Discussion . . . . . . . . . . . 58
W. D. JOHNSON, K. L. KAYSER, P. M. PEDRAZA, AND R. T. SHORE
Employment Patterns in Males Before and After
Myocardial Revascularization Surgery: A Study of 2229
Consecutive Patients Followed for as Long as 10 Years. 60
S. NITTER-HAUGE, T. FR0YSAKER, AND S. SIMONSEN
Reemployment Related to Functional and Hemodynamic
Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 76
VIII Contents
V. CARSTENS, C. RÖGER, H. SCHMITZ, D. W. BEHRENBECK,
AND H. DALlCHAU
Determinants of Vocational Rehabilitation ..... 85
M. SKUPIN, N. REIFART, AND P. SATTER
Incidence of Return to Work in Relation to Invasive,
Noninvasive, and Social Parameters . . . . . . . . . . 93
H. GOHLKE, K. SCHNELLBACHER, H. STEINRÜCKEN, L. SAMEK,
AND H. ROSKAMM
Postoperative Exercise Performance Determines
Return to Work . . . . . . . . . . . . . . . . . . . 102
P. SERGEANT, E. LESAFFRE, W. FLAMENG, AND R. SUY
Predictability of Postoperative Resumption of Work 108
H. MAGOMETSCHNIGG, W. KLEPETKO, S. HANNA,
AND E. DOMANIG
Clinical Results and Return to Work after Coronary Heart
Surgery ............................. 112
Z. HYMOWITZ, D. STEIN, T. TROUDART, A. K. DENouR, J. BORMAN,
A. ApPELBAUM, AND M. S. GOTSMAN
Working Capacity and Psychological Adjustment
Before and After Surgery ................... 115
K. E. HAMMERMEISTER
Summary of the Discussion 121
Return to Work After Coronary Artery Bypass Surgery
in Comparison to Heart Valve Replacement ......... 123
P. J. WALTER, B. IBE, AND M. GOTTWIK
Return to Work After Heart Valve Replacement ...... 125
Return to Work After Coronary Artery Bypass Surgery
in Comparison to Medical Treatment . . . . . . . . . 135
A. OBERMAN, C. FISHER, L. MAYNARD, S. M. MULLlN,
E. D. CHARLES JR., AND F. TRISTANI
Long Term Changes in Work Status Among Patients
in the Coronary Artery Surgery Study Registry ... 137
K. E. HAMMERMEISTER, T. A. DERoUEN, M. ZIA,
AND H. T. DODGE
Comparison of Employment Status Between Medically
and Surgically Treated Coronary Artery Disease
over 6-7 Years .......................... 148
Contents IX
J. JEHLE, P. GROSSMANN, L. KAMPA, M. KLOKE, A. KRIAN,
AND F. LOOGEN
Return to Work After Surgical and Medical Treatment
of Patients with Coronary Artery Disease . . . . . . .. . 155
H. MANNEBACH, U. GLEICHMANN, AND H. SEGGEWISS
Return to Work Aftery Coronary Artery Bypass Surgery
in Comparison with Medical Treatment ........... 163
Return to Work After Coronary Artery Bypass Surgery
in Comparison to Coronary Angioplasty ........... 169
B. MEIER, V. CHAVES, L. V. SEGESSER, B. FAIDUTII,
AND W. RUTISHAUSER
Vocational Rehabilitation After Coronary Angioplasty
and Coronary Bypass Surgery .............. 171
C. VALLBRACHT, G. KOBER, D. SCHERER, AND M. KALTENBACH
Return to Work After Coronary Angioplasty . . . . . . 177
F. BOULAY, P. DAVID, P. R. DAVID, AND M. G. BOURASSA
Work Status and Percutaneous Transluminal Coronary
Angioplasty . . . . . . . . . . . . . . . . . . . . . . . . . 183
C. COUSTRY-DEGRE, E. STOUPEL, P. VANDERMOTEN, J. L. LECLERC,
J. STRUYVEN, AND S. DEGRE
Return to Work After Thrombolysis According
to the Subsequent Treatment ................. 191
P. G. HUGENHOLTZ
Summary of the Discussion . 193
Psychosocial and Behavioral Aspects of Coronary Artery
Bypass Surgery ......................... 201 .
U. GERHARDT
The Discrepancy Between Social and Medical
Rehabilitation of Patients with Coronary Heart Disease . 203
M. c. GUTMANN, D. N. KNAPp, AND M. L. POLLOCK
Psychosocial Predictors of Work Status 209
A. E. WILLNER AND C. J. RABINER
Psychiatrie Complications . . . . . . . . 214
H.-J. MEFFERT, A. BOLL, G. HUSE-KLEINSTOLL, F. LEMPP,
G. RODEWALD, AND H. SPEIDEL
Benefits and Psychologieal Problems of Aortocoronary
Bypass and Valve Replacement Surgery ........... 219
X Contents
D. S. KORNFELD, S. S. HELLER, K. A. FRANK, S. N. WILSON,
AND J. R. MALM
Psychological and Behavioral Responses ...... ... 224
M. BENYAKAR, S. MIBASHAN, L. LEVINSKY, C. ROSEMBERG,
Y. FucHs, AND M. J. LEVY
Return to Work and Sexual Relations Among Patients
Following Coronary Artery Bypass Grafting and
Myocardial Infarction ............... . . 235
M. J. LEVY, M. BENYAKAR, S. MIBASHAN, L. LEVINSKY,
C. ROSEMBERG, AND Y. FUCHS
Sexual Relations and the Perception of Health and
Happiness Among Patients Following Coronary Artery
Bypass Crafting and Myocardial Infarction . . . . 246
G. BERGMANN, M. WELSCH, W. SAGGAU, AND H. FERNER
Psychosocial Aspects . . . . . . . . . . . . . . . . . . 257
A. BOLL, J. KOCH, A. SHEIKHZADEH, P. THORAN,
AND A.-F. LANGBEHN
Psychological Adaptation of Patients in the Early
Rehabilitative Phase After Heart Surgery ..... 265
M. HALHUBER
Some Questions and Remarks 273
D. S. KORNFELD
Summary of the Discussion . . 275
Economic Considerations: Costs of Coronary Artery Bypass
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 277
J. J. COLLINS JR.
Comparison of Costs for Medical and Surgical Treatment
of Coronary Obstructive Disease . . . . . . . . . . . . . . . 279
P. KALMAR, M.-J. POLONIUS, K.-J. HAHN, I. RADTKE,
AND G. RODEWALD
Costs of Open Heart Surgery: ACVB Surgery vs Valve
Replacement .................... 285
W. J. KEON, S. C. MENZIES, AND C. M. LAY
The Costing of Coronary Artery Bypass Surgery 292
W. B. STASON AND M. C. WEINSTEIN
Cost-Effectiveness of Coronary Artery Bypass Surgery 299
F. UNGER
Cost-Effectiveness in Coronary Artery Surgery:
In Relation to the Gross National Product ... . 307
H. SILOMON
The Contribution of Social Medicine to the Cost-Benefit
Analysis of Coronary Bypass Surgery ............ 315
Contents XI
W. B. STASON
Summary of the Discussion .................. 318
Rehabilitation and Return to Work: Strategies for Improving
the Work Status of Patients After Coronary Artery Bypass
Surgery ......................... 321
N. K. WENGER, D. ALMEIDA, J. M. BRADFORD, S. B. KING,
AND J. W. HURST
Return to Work Mter Coronary Bypass Surgery: Problems
and Prospects . . . . . . . . . . . . . . . . . . . . . . 323
F. BOULAY, P. DAVID, N. DANCHIN, AND M. G. BOURASSA
Can We Improve Work Status After Surgery? 332
H. V. LIDDLE, P. D. JONES, B. GOULD, AND P. D. CLA YTON
The Rehabilitation of Patients Following Coronary
Revascularization Surgery: Social and Economic Aspects . 341
E. GRODZINSKI, T. FENTROP, T. KELLER, G. BIERCK, J. S. BORER,
W. SCHOOP, AND G. BLÜMCHEN
The Significance of Radionuclide Ventriculography for
the Prognosis and Social Fate of Heart Infarction Patients
(With or Without Left Ventricular Aneurysm) 354
R. A. M. ERDMAN, AND P. G. HUGENHOLTZ
Comparison of Active Participation in the Rotterdam
Outpatient Cardiac Rehabilitation Pro gram and Horne
Rehabilitation: A 5-Year Follow-up of a Controlled
Clinical Trial on Psychological Well-Being: A
Presentation on Behalf of CAPRI ........ .... 365
W. F. DION, M. L. POLLOCK, C. FOSTER, P. GREVENOW,
S. SENNETT, AND D. H. SCHMIDT
Medical Problems and Hemodynamic Responses of
Myocardial Revascularization Surgery Patients to Early
Cardiac Rehabilitation . . . . . . . . . . . . . . . . . . . . . 369
G. STEIN, H. JUNG MANN, E. O. KRASEMANN, AND M. ZOTHNER
Inability to Work After Myocardial Infarction: A 5-Year
Follow-up Study ....................... 375
B. RIGLER, F. IBERER, J. KRAFT-KINZ, AND W. KLEIN
Postoperative Work Rehabilitation ..... . 380
C. SEIDEL, U. STOCKSMElER, AND R. WEGSCHEIDER
Survival After Return to Work ..... 386
A. VERMEULEN, J. J. KOOLEN, A. C. MOULIJN,
AND N. SLANGEN-SCHOTERMANN
Cardiac Rehabilitation: Influence on Work Resumption 390
N. K. WENGER
Summary of the Discussion . . . . . . . . . . . . . . . .. 394