Volume 26, Issue 1 (Winter 2019)                   Intern Med Today 2019, 26(1): 2-13 | Back to browse issues page

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Paryad E, Balaafkandah A, Ghanbari A. Factors Predicting Daily and Instrumental Living Activities in Obese and Overweight Patients After Coronary Artery Bypass Graft Surgery. Intern Med Today 2019; 26 (1) :2-13
URL: http://imtj.gmu.ac.ir/article-1-3123-en.html
1- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.; GI cancer Screening & Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran.
2- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
3- GI cancer Screening & Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran. , at_ghanbari@gums.ac.ir
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1. Introduction

oronary Heart Disease (CHD), also called coronary artery disease, has become widespread due to lifestyle changes. In addition to causing care and economic costs, this disease is also one of the most important causes of disability [1]. The number of Coronary Artery Bypass Graft (CABG) surgeries in the United States is estimated at 213700 per year [2]. In Iran, 16,000 to 18,000 people undergo CABG surgery [3, 4]. There are several under lying causes of this disease. One is the overweight and obesity [5, 6], leading to an increase in the cost of surgery, damage to the healthcare system [7], and an increase in the length of hospital stay in the cardiac surgery intensive care unit (ICU) and other wards [8, 9]. Obviously, patients’ ability to perform daily activities after heart surgery is reduced, and obesity and overweight may increase at this time frame and have a deeper impact on the patient and his family’s life [10, 11].

2. Materials and Methods

Research population, place, and time: The study population included obese and overweight patients undergoing CABG surgery hospitalized in the cardiac surgery wards of the hospital affiliated to Guilan University of Medical Sciences in July to September 2018, in access manner (N=84).

A questionnaire containing four sections of individual and disease-related characteristics, Carlson Comorbidity Index (19 questions), Katz Index (16 questions in 7 sections) and Luton’s Instrumental Activity of Daily Living (IADL) scale were used.

3. Results

Findings showed that most p patients were in t he following conditions: in the age group of 65 and under (79. 8%), male (59. 5%), married (98. 8%), primary education (34. 5%), left ventricular outflow fraction less than 50% (82. 1%), with more than two children (76. 2%), with transplants more than 3 vessels (72. 6%), no smoking (67. 9%)), and no carotid artery occlusion (70. 2%). According to the results, there was no significant relationship between Body Mass Index (BMI) and in the ADL and IADL status before and one month after surgery.

In the case of IADL, the variables entered the logistic regression model, in which the sex variables (P=0. 004, OR=10. 51, 95. 1%=15. 41), the carotid artery occlusion (P=0. 01, 0. 12= OR, 0. 64-0. 62%=CI 95%), and the IADL predictors showed obese and overweight in the patients. The men were 10.51 times more capable than women in practicing IADL a month later were. Patients with carotid artery occlusion were 0.12 times less likely than other patients.

4. Discussion

Obese or overweight people were able to get ADL one month after surgery. While for IADL they often needed help and dependency. This finding is consistent with the results of several studies in this case [10, 12, 13]. Because most male patients were around 59 years old, had an underlying disease, and because the economic responsibility and livelihood of the family are the responsibility of the men, these people are forced to return to work. A combination of these factors may cause financial and economic problems for the patient, healthcare systems, and society. In the case of more postoperative complications, overweight and obese patients are more likely to develop underlying conditions such as diabetes [14].

In the one month after surgery, there was a significant association between patients’ ADL and their education, the length of cross-clamping of the thoracic aorta, the duration of use of the cardiopulmonary bypass pump, and the use of Beta blockers. The results of a study by Stamou et al. showed that the duration of use of cardiopulmonary bypass pump and cross-clamping pump of the aorta are influential variables [15].

The results of the study by Lehmkuhl et al. showed that the level of education is one of the influential factors in obese people to perform ADL after surgery [16]. One month after the operation, there was a significant relationship between the status of ADL of patients with sex, occupation, education, smoking, and carotid artery occlusion. The results of a study by Najafi et al. indicated that sex is one of the influential factors in obese or overweight people [17, 18].

In connection with the predictive factors of the status of IADL within one month after Coronary Artery Bypass Grafting (CABG), the results showed that the sex and non-carotid artery occlusion in patients are predictive variables.

The results of a study showed that the sex of patients with obesity undergoing CABG surgery is one of the factors reducing the functional status of patients in the postoperative stage [19]. De Rosa et al. showed that people with overweight or obese who had carotid artery occlusion before surgery were less capable, and that 50% carotid artery occlusion was a predictive factor for mortality [20].

5. Conclusion

Obese and overweight people have a disability in their ADL performance, and it is important to pay attention to the predictors, including men and the carotid artery occlusion in their return to normal life after surgery.

Restrictions and suggestions

Using a questionnaire and telephone follow-up in one month after the operation and the low sample size are the limitations of this research. Instead of a questionnaire, the observation method with a different design and higher sample size can be used to examine the ability of IADL.

Ethical Considerations

Compliance with ethical guidelines

This study was approved (Ethics Code: IR.GUMS.REC.1395.86) in the ethics committee of Guilan University of Medical Sciences.


The present paper was extracted from the MSc. thesis of the first author, Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences and supported financially by the Vice Chancellor for Research and Technology of Guilan University of Medical Sciences (Code: 27272).

Authors' contributions

All authors contributed in preparing this article.

Conflicts of interest

The authors declared no conflict of interest.


The authors would like to thank all the officials of Guilan University of Medical Sciences for permiting to conduct the research, as well as the patients participated in the cardiac surgery department in this study.



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Type of Study: Original | Subject: Surgery
Received: 2019/01/28 | Accepted: 2019/11/18 | Published: 2020/01/1

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