When compared to their married counterparts, patients 50 years of age and older who were divorced, separated, or widowed had about 40% greater odds of dying or developing a new functional disability during the first 2 years after cardiac surgery, Mark D. Neuman, MD, MSc, and Rachel M. Werner, MD, PhD, reported online in JAMA Surgery.
Neuman and Werner are both with the School of Medicine at the University of Pennsylvania in Philadelphia.
“Our study suggests that social supports can be important in terms of functional recovery,” said Neuman in an interview with MedPage Today. “It’s important to see the whole patient in their environment when thinking of predictors of outcomes after surgery. It’s not just a patient’s chart that matters.”
Characterizing the association between marital status and postoperative function may be useful for counseling patients and identifying at-risk groups that may benefit from targeted interventions aimed at improving functional recovery, according to the investigators.
“These findings extend previous work suggesting postoperative survival advantages for married people, and may relate to the role of social supports in influencing patients choices of hospitals and their self-care,” they said.
Data for the study were pulled from the University of Michigan Health and Retirement Study, a longitudinal panel survey that since 1998 has enrolled almost 30,000 adults 50 years of age and older. Participants in the health and retirement study are interviewed every 2 years to establish their health, functional ability, medical care, and family structure.
Neuman and Werner used data from 2004, 2006, 2008, and 2010 interviews and included participants who had undergone cardiac surgery since the last interview. Reports on deceased participants were provided by proxy.
In addition to information on marital status, age, sex and comorbidities, Neuman and Werner collected information on preoperative dependence in six activities of daily living: dressing, ambulation, bathing, eating toileting and getting into and out of bed. The end point was a combined outcome of death or new dependence in one or more activities of daily living at the post-surgery interview.
The x2 test and the Kruskal-Wallis test were used to compare patient characteristics at baseline. After accounting for baseline characteristics, logistic regression was used to test the association of marital status with postoperative death or new functional dependence, said the investigators.
In all, the study sample included 1,576 participants. At the baseline interview, 63.1% were married, 11.7% were divorced or separated, 21.0% were widowed, and 2.2% were never married.
Married participants were more likely to be male (74.1%) and to demonstrate lower degrees of comorbidity and disability before surgery, said Neuman and Werner. Forty-five patients died before the next Health and Retirement Study interview; and 326 (20.7%) survived but became dependent in one or more daily living activities, they said.
At the post-surgery interview, no statistically significant differences in mortality according to marital status were observed, said the investigators. The results showed that the following had either died or developed a new disability (P<0.001):
- 19.4% of the 1,016 married participants
- 28.8% of the 184 divorced or separated participants
- 33.8% of the 331 widowed participants
- 20.0% of the 35 participants who had never been married
After accounting for baseline characteristics, however, marital status remained significantly associated with death or a new functional disability, said the investigators. Compared with married participants, the odds ratio for death or a new functional disability was:
- 1.55 among divorced or separated participants (95% CI 1.06-2.28; P=0.02); and
- 1.60 among participants who were widowed at baseline (95% CI 1.15-2.23; P=0.01).
Limitations of this study include the possibility that the participants may have differed in ways other than marital status. The investigators noted, however, that the study findings persisted in multivariate models that controlled for multiple baseline factors.
More research is needed to define the mechanisms linking marital status and postoperative outcomes, they said. “We thought that a provocative preliminary study might lead to other studies of this nature,” Neuman told MedPage Today.
From the American Heart Association: