Abstract
Higher levels of resilience and spirituality are independently linked to better physical and mental health outcomes, within both general and cardiac populations. We investigated the long-term associations of such psychological factors following cardiac surgery. A total of 402 patients undergoing routine cardiac surgery at two large urban hospitals in the Dallas, Texas, area were prospectively enrolled in this study, with completed follow-up data for 364 (90.5%). Data were collected from August 2013 to January 2017. Resilience, spirituality, and secondary measures were assessed at baseline, 1 month, and 1 year via the Connor-Davidson Resilience Scale-10 and Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale. Linear regression and correlational analyses assessed associations between resilience and spirituality, as well as other demographic and psychosocial factors. Resilience was significantly associated with every construct except posttraumatic growth. Spirituality was associated with increasing resilience over the ensuing year, whereas never being married was associated with a decrease in resilience. Our findings identify a population that is vulnerable to a decrease in resilience following cardiac surgery, as well as an avenue (i.e., spirituality) for potentially bolstering resilience. Improving resilience via spirituality postoperatively may foster better overall recovery and better mental and physical health outcomes.
Keywords: Cardiac surgery, resilience, spirituality, surgical outcomes, surgical recovery
Higher psychological resilience is linked to better mental and physical health, including fewer depressive symptoms, less chronic pain, and decreased hypertension.1,2 Spirituality is also independently associated with better health outcomes, both in general medical populations and cardiac patients.3,4 Such psychological factors are thought to play a role in the cardiac surgery recovery process; however, long-term data on their influence are lacking. In the current era of patient-centric medicine, there is increasing interest in modulating psychological factors as a means of enhancing surgical outcomes. To this end, we sought to investigate the long-term associations of resilience with spirituality and other psychosocial factors following cardiac surgery in a nonemergent, all-comers population. We hypothesized that 1) highly resilient patients at the time of surgery would display greater mental health compared to less resilient patients, and 2) changes in resilience would be facilitated by changes in spirituality.
METHODS
With institutional review board approval (#013-012) and informed consent, we prospectively enrolled 402 patients undergoing elective cardiovascular surgery at The Heart Hospital Baylor–Plano and Baylor University Medical Center from August 2013 through January 2017. The surgeries included coronary artery bypass grafting (CABG), aortic valve repair, mitral valve repair, tricuspid annuloplasty, maze, other, and/or any revision procedure. Inclusion criteria at recruitment were as follows: aged ≥ 35 years, English speaking, able to give informed consent, and permitted to participate in the study by the surgeon.
Up to 72 hours before surgery, subjects completed baseline measures that assessed demographic variables, resilience, spirituality, quality of life, depression, anxiety, and perceived level of social support. Posttraumatic growth was also assessed 1-year postoperatively. Information was gathered from the Society for Thoracic Surgeons Adult Cardiac Surgery Database. In addition to baseline information, patients completed 1-month (±7 days) and 1-year (±14 days) follow-up questionnaires via online survey collection tools (Snap Survey Software) or via telephone with a clinical research associate. Data collection was considered complete 1 year following the patient’s date of surgery. A total of 396 participants were included in baseline comparisons, 341 at 30 days, and 305 at 1 year (Figure 1).
Figure 1.
CONSORT diagram of study participant enrollment.
The Connor-Davidson Resilience Scale-10 (CD-RISC) is a 10-item self-report resilience inventory that has been widely used to assess resilience within cardiac populations.5,6 Numerous studies have established the reliability, validity, and factor analytic structure of the scale.7,8 The scale has strong internal consistency (Cronbach’s alpha = 0.89) and strong test-retest reliability (intraclass correlation coefficient = 0.87).
The Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp-12) is a widely used 12-item measure of spiritual well-being.9 Patients are asked to describe aspects of spirituality and/or faith that are related to their health over the past 7 days. Items are on a 5-point Likert scale with choices ranging from ‘not at all’ to ‘very much.’ The FACIT-Sp-12 has strong internal consistency for both the full scale and the underlying subscales (Cronbach’s alphas ranging from 0.81 to 0.88).9 The FACIT-Sp-12 has also displayed adequate validity9 and has been used to assess spirituality in cardiac populations.10
Secondary measures assessed for anxiety, depression, social support, quality of life, and posttraumatic growth. The following validated and reliable self-report measures were chosen given their superior psychometrics and established use within either medical or cardiac populations: The Hospital Anxiety and Depression Scale (HADS-A, HADS-D),11 which has been used widely within cardiovascular patients12,13; the Multidimensional Scale of Perceived Social Support (MSPSS)14; The Kansas City Cardiomyopathy Questionnaire (KCCQ) quality of life (QOL) subscale, which is a chronic disease–specific QOL measure associated with heart failure15,16; and the Post Traumatic Growth Inventory (PTGI).17
All analyses were performed in SAS 9.4,18 and statistical significance was defined as <0.05 with a two-tailed test, unless otherwise noted. To test Hypothesis 1, we used our sample’s median CD-RISC score of 34 to classify patients as having high resilience (HR) or low resilience (LR) based on baseline scores. Although a national average of 32 was previously found,19 the higher median found in our sample may be better representative of the study’s target population. Patient characteristics were compared between groups using t tests or Mann-Whitney U tests for numeric variables and chi-square or Fisher’s exact tests for categorical variables. Comparisons that were significant at the 0.1 level were used in further analyses to control for differences between groups, including age, Hispanic ethnicity, self-rated health, history of cancer, history of depression, history of anxiety, and surgery type. Past surgical history was not gathered.
Psychosocial measures were first compared via unadjusted t tests or Mann-Whitney U tests for numeric variables and chi-square or Fisher’s exact tests for categorical variables. Adjusted analyses were then performed using linear or logistic regression, as appropriate.
To test Hypothesis 2, we calculated 1-year pre-post change scores of applicable psychosocial measures. We then evaluated unadjusted associations between change in CD-RISC score and patient characteristics. Pearson correlations were calculated for the association between change in CD-RISC and either the change in score for each measure or the score at the time point taken for MSPSS (Baseline) and PTGI (12 months).
Analysis was performed using a general linear model to determine which factors were associated with change in resilience while adjusting for patient characteristics, baseline CD-RISC, and psychosocial measures. A history of depression, anxiety, and insurance payer status were also included in this model. To reduce the number of variables, a model was first run including only the demographic and clinical characteristics. Variables that were significant at the 10% level were included in the final model.
RESULTS
At baseline, 396 patients completed the CD-RISC. The average age of study participants was 65 years old, with 65% male and 90% white/Caucasian race. Approximately 76% were married or living with a partner, 57.4% self-rated their health as “good” or “very good,” and 69.5% had more than 12 years of education. Most patients (69.4%) were treated at The Heart Hospital Baylor–Plano and the predominant procedure performed was isolated CABG (33.6%), followed by mitral valve repair/replacement, ± maze, ± any revision (23.2%), aortic valve replacement ± other procedure (20.5%), other/not listed (11.9%), and CABG/valve ± maze (10.9%).
The average overall baseline psychosocial scores and standard deviations are as follows: CD-RISC was 33.6 ± 5.4; FACIT-Sp-12, 40.2 ± 6.9; MSPSS, 77 ± 8.4; HADS-D, 3.7 ± 3.0; and HADS-A, 5.9 ± 4.4. QOL scores within the KCCQ averaged 55.4 ± 26. At baseline, the CD-RISC was significantly (P < 0.0001) correlated with FACIT-Sp-12 (r = 0.52), HADS-A (r = −0.46), HADS-D (r = −0.37), MSPSS (r = 0.35), and QOL (r = 0.29).
Of the 396 people who completed the baseline CD-RISC assessment, 176 (44%) were classified as LR and 220 (56%) were classified as HR via the median CD-RISC score of 34. HR patients were significantly older (66 ± 10.8 vs 63.6 ± 11.8, P < 0.05), more frequently rated their health as “very good” or “good,” and less frequently self-reported their race/ethnicity as Hispanic. Table 1 summarizes baseline demographic and clinical characteristics.
Table 1.
Baseline summary of demographic factors comparing those with high vs low resilience
| Variable | Resilience |
P
value |
|
|---|---|---|---|
| Low (n = 176) | High (n = 220) | ||
| Age (years): mean ± SD | 63.6 ± 11.8 | 66 ± 10.8 | 0.0323 |
| Weight (lbs): mean ± SD | 197.6 ± 51.6 | 197.3 ± 51.6 | 0.9503 |
| Height (in): mean ± SD | 67.8 ± 4.3 | 69.2 ± 11.9 | 0.1176 |
| Body mass index (kg/m2): mean ± SD | 30.2 ± 7.3 | 30.2 ± 15.4 | 0.9935 |
| Men | 114 (64.8%) | 142 (64.5%) | 0.9625 |
| Race | 0.1201 | ||
| White | 157 (89.2%) | 198 (90%) | |
| Black/African American | 16 (9.1%) | 12 (5.5%) | |
| Other | 3 (1.7%) | 10 (4.5%) | |
| Hispanic/Latino | 10 (5.7%) | 4 (1.8%) | 0.0407 |
| Marital status | 0.2706 | ||
| Married/living with partner | 126 (71.6%) | 174 (79.1%) | |
| Separated/divorced | 30 (17%) | 23 (10.5%) | |
| Widowed | 13 (7.4%) | 16 (7.3%) | |
| Never married | 6 (3.4%) | 7 (3.2%) | |
| Refused | 1 (0.6%) | 0 (0%) | |
| Education | 0.7112 | ||
| No high school diploma/GED | 19 (10.8%) | 18 (8.2%) | |
| High school diploma/GED | 40 (22.7%) | 44 (20%) | |
| Some college/associate’s degree | 60 (34.1%) | 74 (33.6%) | |
| Bachelor’s degree | 30 (17%) | 47 (21.4%) | |
| Graduate degree | 27 (15.3%) | 37 (16.8%) | |
| Insurance | 0.3279 | ||
| Public insurance (Medicare, Medicaid, Champus) | 91 (51.7%) | 122 (55.5%) | |
| Private/employer sponsored | 78 (44.3%) | 84 (38.2%) | |
| Self-pay | 3 (1.7%) | 8 (3.6%) | |
| Other | 4 (2.3%) | 6 (2.7%) | |
| Working | 67 (38.1%) | 99 (45%) | 0.1648 |
| Religious attendance | 0.1153 | ||
| Active member (more than once per week) | 37 (21%) | 48 (21.8%) | |
| Regularly attend (once per week) | 38 (21.6%) | 66 (30%) | |
| Member (do not regularly attend) | 52 (29.5%) | 64 (29.1%) | |
| Do not attend | 49 (27.8%) | 42 (19.1%) | |
| Self-rated health | 0.0005 | ||
| Very good | 21 (11.9%) | 43 (19.5%) | |
| Good | 58 (33%) | 105 (47.7%) | |
| Average | 35 (19.9%) | 26 (11.8%) | |
| Fair | 27 (15.3%) | 21 (9.5%) | |
| Poor | 35 (19.9%) | 25 (11.4%) | |
GED indicates General Educational Development; SD, standard deviation.
Table 2 summarizes baseline differences between resilience groups with respect to psychosocial factors. In the unadjusted analyses, HR patients displayed higher scores in the following measures: CD-RISC (37.5 ± 2.1 vs 28.6 ± 4), FACIT-Sp-12 (43 ± 4.8 vs 36.8 ± 7.6), MSPSS (79 ± 8 vs 74.6 ± 8.2), all P < 0.001, and QOL (61.5 ± 24.8 vs 47.7 ± 25.4; P < 0.05). Within the adjusted analyses, all of the aforementioned scores remained significantly different, P < 0.05. LR patients displayed higher rates of anxiety (7.6 ± 4.4 vs 4.6 ± 4) and depression (4.9 ± 3.3 vs 2.8 ± 2.5), P < 0.001.
Table 2.
Baseline psychosocial measures comparing those with high vs low resilience
| Baseline measure |
Scale
range * |
Resilience |
P value |
||
|---|---|---|---|---|---|
| Low (n = 176) | High (n = 220) | Unadjusted | Adjusted | ||
| CD-RISC | 0–40 (h) | 28.6 ± 4 | 37.5 ± 2.1 | <0.001 | <0.001 |
| FACIT-Sp-12 | 0–52 (h) | 36.8 ± 7.6 | 43 ± 4.8 | <0.001 | <0.001 |
| Meaning/Peace Domain | 0–32 (h) | 24.6 ± 4.7 | 29.3 ± 3 | <0.001 | <0.001 |
| Faith Domain | 0–16 (h) | 12.2 ± 4.3 | 13.7 ± 3.4 | 0.0001 | 0.005 |
| MSPSS | 74.6 ± 8.2 | 79 ± 8 | <0.001 | <0.001 | |
| HADS Anxiety total score | 0–21 (l) | 7.6 ± 4.4 | 4.6 ± 4 | <0.001 | <0.001 |
| HADS Anxiety category | <0.001 | <0.001 | |||
| Non-case | 0–7 (l) | 38 (21.6%) | 21 (9.5%) | ||
| Borderline | 8–10 (l) | 92 (52.3%) | 179 (81.4%) | ||
| High acuity | 11–21 (l) | 46 (26.1%) | 20 (9.1%) | ||
| HADS Depression total score | 0–21 (l) | 4.9 ± 3.3 | 2.8 ± 2.5 | <0.001 | <0.001 |
| HADS Depression category | <0.001 | 0.004 | |||
| Non-case | 0–7 (l) | 11 (6.3%) | 1 (0.5%) | ||
| Borderline | 8–10 (l) | 138 (78.4%) | 205 (93.2%) | ||
| High acuity | 11–21 (l) | 27 (15.3%) | 14 (6.4%) | ||
| KCCQ Quality of Life | 0–100 (h) | 47.7 ± 25.4 | 61.5 ± 24.8 | <0.001 | 0.005 |
CD-RISC indicates Connor-Davidson Resilience Scale; FACIT-Sp-12, Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being; HADS, Hospital Anxiety and Depression Scale; KCCQ, Kansas City Cardiomyopathy Questionnaire; MSPSS, Multidimensional Scale of Perceived Social Support. Models were adjusted for age, Hispanic ethnicity, self-rated health, history of cancer, history of depression, history of anxiety, and surgery type.
h = higher more desirable; l = lower more desirable.
Thirty days after surgery, 146 patients in the LR group and 195 in the HR group had at least partial responses to the assessment. HR patients continued to display significantly greater self-health ratings compared to the LR group, unadjusted P = 0.0002. HR patients displayed significant differences with respect to most psychosocial measures in the unadjusted analyses, such as FACIT-Sp-12, HADS-A, HADS-D, and QOL.
At 12 months after surgery, 130 patients in the LR group and 175 in the HR group had at least partial responses to the assessment. HR patients continued to self-rate themselves as healthier than LR patients (P < 0.05) in the unadjusted analyses. Additionally, several measures were significantly different between groups in the unadjusted analysis, including measures of spirituality, anxiety, depression, and QOL, all P < 0.05 (Table 3). However, adjusted analyses revealed that HR and LR groups differed on overall FACIT-Sp-12 scores, the Meaning/Peace subdomain of FACIT-Sp-12, HADS-A Borderline Category, and KCCQ Symptom Stability. No differences were observed in the overall PTGI or any subscale (P > 0.05).
Table 3.
12-month psychosocial measures comparing those with high vs low resilience
| Measure | Resilience |
P value |
||
|---|---|---|---|---|
| Low (n = 130) | High (n = 175) | Unadjusted | Adjusted | |
| CD-RISC | 30.0 ± 6.8 | 35.0 ± 5.1 | <0.0001 | <0.0001 |
| FACIT-Sp-12 | 37.4 ± 8.9 | 42.1 ± 6.7 | <0.0001 | 0.0014 |
| Meaning/Peace | 25.1 ± 5.9 | 28.5 ± 4.4 | <0.0001 | 0.0006 |
| Faith | 12.3 ± 4.3 | 13.6 ± 3.7 | 0.0048 | 0.0729 |
| HADS Anxiety | 4.7 ± 3.6 | 3.3 ± 3.3 | 0.0013 | 0.2150 |
| Borderline | 104 (80%) | 156 (89.1%) | 0.1351 | 0.4685 |
| High acuity | 17 (13.1%) | 14 (8%) | ||
| Non-case | 9 (6.9%) | 5 (2.9%) | ||
| HADS Depression | 3.2 ± 3.4 | 2.1 ± 2.7 | 0.0028 | 0.5398 |
| Borderline | 118 (90.8%) | 169 (96.6%) | 0.0298 | 0.7583 |
| High acuity | 8 (6.2%) | 1 (0.6%) | ||
| Non-case | 4 (3.1%) | 5 (2.9%) | ||
| KCCQ Quality of Life | 81.2 ± 21.8 | 86.8 ± 19.9 | 0.0190 | 0.6893 |
| PTGI | 50.2 ± 31.8 | 47.2 ± 34 | 0.4181 | 0.7842 |
| Domains | ||||
| Relating to Others | 18.3 ± 10.7 | 16.8 ± 11.8 | 0.2599 | 0.6074 |
| New Possibilities | 9.5 ± 7.8 | 9.3 ± 8.3 | 0.8282 | 0.6868 |
| Personal Strength | 9.6 ± 6.6 | 9.1 ± 7.1 | 0.4983 | 0.6787 |
| Spiritual Change | 4.8 ± 4 | 4.1 ± 3.9 | 0.1574 | 0.2256 |
| Appreciation of Life | 8 ± 4.7 | 7.8 ± 5.2 | 0.6928 | 0.8025 |
CD-RISC indicates Connor-Davidson Resilience Scale; FACIT-Sp-12, Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being; HADS, Hospital Anxiety and Depression Scale; KCCQ, Kansas City Cardiomyopathy Questionnaire; PTGI, Post Traumatic Growth Inventory. Models were adjusted for age, Hispanic ethnicity, self-rated health, history of cancer, history of depression, history of anxiety, and surgery type.
Of the 396 participants who completed the baseline CD-RISC assessment, 305 patients also completed the 12-month assessment. There was no difference in baseline CD-RISC scores from those who did and did not complete follow-up (33.8 ± 5.3 vs 32.7 ± 5.7, P = 0.32). Race, body mass index, education level, and history of anxiety disorder were associated with change in resilience, P < 0.05. Change scores from both domains of the FACIT-SP-12 and the physical limitation, QOL, and social limitation domain scores of the KCCQ had significant positive correlations with change in CD-RISC scores. Change scores in HADS-A and HADS-D had significant negative correlations with change in CD-RISC, all P < 0.05.
Table 4 displays the results of the final regression model (R2 = 0.48). Patient characteristics included in the final model were baseline CD-RISC, body mass index, race, marital status, education, and history of depression. Controlling for these variables, the Meaning/Peace and Faith domains of the FACIT-SP-12 were both associated with an increase in resilience, whereas never being married was significantly associated with a decrease in resilience in the year following surgery, P < 0.05. Figures 2 and 3 illustrate the relationship between the two FACIT-Sp-12 domains and CD-RISC.
Table 4.
Regression analysis results for outcome of change in resilience
| Psychosocial construct | Beta (SE) | P value |
|---|---|---|
| Baseline CD-RISC | −3.80 (0.62) | <0.0001 |
| Body mass index | −0.02 (0.02) | 0.3054 |
| Race | ||
| White | ||
| Black/African American | −2.15 (1.25) | 0.0876 |
| Other | 0.81 (1.35) | 0.5503 |
| Marital status | ||
| Married | ||
| Separated/divorced | 1.07 (0.91) | 0.2392 |
| Widowed | 0.29 (1.18) | 0.8082 |
| Never married | −6.19 (1.86) | 0.0010 |
| Education | ||
| No high school diploma or GED | ||
| High school/GED | 0.82 (1.22) | 0.5030 |
| Some college/associate’s degree | 0.44 (1.14) | 0.7006 |
| Bachelor’s degree | 1.87 (1.26) | 0.1398 |
| Graduate degree | 2.24 (1.30) | 0.0858 |
| History of depression | −1.91 (0.81) | 0.0191 |
| Perceived social support | 0.06 (0.04) | 0.1438 |
| Change in FACIT | ||
| Meaning/Peace | 0.4 (0.08) | <0.0001 |
| Faith | 0.3 (0.10) | 0.0042 |
| Change in HADS | ||
| Depression | −0.17 (0.11) | 0.1273 |
| Anxiety | 0.13 (0.08) | 0.0778 |
| Change in quality of life | 0.02 (0.01) | 0.1882 |
| PTGI | ||
| Relating to Others | −0.05 (0.07) | 0.4741 |
| New Possibilities | −0.16 (0.08) | 0.0500 |
| Personal Strength | 0.21 (0.13) | 0.1034 |
| Spiritual Change | −0.22 (0.15) | 0.1525 |
| Appreciation of Life | 0.14 (0.12) | 0.264 |
CD-RISC indicates Connor-Davidson Resilience Scale; FACIT, Functional Assessment of Chronic Illness Therapy; GED, General Educational Development; HADS, Hospital Anxiety and Depression Scale; PTGI, Post Traumatic Growth Inventory.
Figure 2.
Scatterplot of change in Functional Assessment of Chronic Illness Therapy (FACIT-Sp-12) Meaning/Peace score with change in Connor-Davidson Resilience Scale (CD-RISC) score.
Figure 3.
Scatterplot of change in Functional Assessment of Chronic Illness Therapy (FACIT-Sp-12) Faith score with change in Connor-Davidson Resilience Scale (CD-RISC) score.
DISCUSSION
HR patients were more spiritual, less anxious, and less depressed, had higher levels of perceived social support, had higher self-efficacy, and displayed greater QOL. HR patients also self-rated their health as higher compared to LR patients at each time point. Clearly, resilience is associated with greater perceived health following cardiac surgery. We have also demonstrated that spirituality is associated with an increase in resilience in the year following cardiac surgery. Conversely, never being married is associated with a decrease in resilience. We observed no differences between resilience groups with respect to posttraumatic growth 1 year after surgery. Our findings also bring additional clarity to the broader examination of psychosocial factors following surgery; researchers have cited the need for longer-term follow-up periods in this area, as the majority of studies examining psychosocial constructs following cardiac surgery have been limited to 6 months or less.20 For these and other reasons, both spirituality and resilience merit increased attention in the cardiac surgery population.
Longitudinally, our results suggest that spirituality can influence resilience, which could then foster better recovery. However, research is still needed to demonstrate that increasing spirituality preoperatively will correlate with increased resilience. Preliminary evidence suggests that resilience can be trained in a brief and cost-effective manner. In a randomized trial, Steinhardt and Dolbier21 demonstrated in a sample of college students that 4 weeks of resilience-oriented psychoeducation sessions resulted in higher resilience as well as decreased depressive symptoms and perceived stress. Similarly, Loprinzi et al22 showed that a brief psychoeducational resilience intervention led to significantly increased resilience and QOL, as well as decreased anxiety and perceived stress in breast cancer survivors 12 weeks after cancer treatment. A similar intervention also proved effective in a single psychoeducation session.23
Additionally, Min and colleagues24 demonstrated that low spirituality was an independent predictor of low resilience in patients with psychiatric illness. We know that level of resilience is correlated with better mental and physical health.1,2 However, it could be that supporting spiritual growth perioperatively will increase both spirituality and resilience, and the patient will benefit from the salutary benefits of both. To our knowledge, resilience training has not been examined in cardiac patients, nor has long-term data been collected regarding how sustained these ‘trained’ benefits would be. Perhaps the efficacy of resilience training interventions could be augmented even further by supporting spirituality. This is an area indicated for future research. Regarding other factors, QOL has previously been shown to improve 1 year after cardiac surgery.25
Our sample was primarily white, male, and had a high level of education, which limits the generalizability of our findings. Additionally, with technological advancements in perioperative care, many of the surgeries employed are no longer considered life-threatening and thus the relative safety of these procedures may have influenced patients’ perceptions of how ‘traumatic’ they would be. In other words, the surgeries may not have been stressful enough to demonstrate even more significant findings. A significant number of competing valve studies within both recruitment sites siphoned many of the higher-risk cardiac patients. Thus, the relative health of our sample could impact the generalizability of our findings. In addition, some follow-up assessments were done in person and some through an online tool, which could introduce measurement bias if the mode of follow-up impacted the responses. Our observational design does not allow for us to assert causality with this study’s findings. However, our minimally intrusive study design with nonfrequent follow-up periods more closely reflects the ‘average’ cardiac surgery patient’s experience.
To our knowledge, this is the first study to examine the long-term associations of resilience with psychosocial constructs in cardiovascular surgery patients. Patients with HR displayed higher levels of spirituality, perceived social support, and QOL, as well as less depression and anxiety, both at baseline and in the year following surgery. Conversely, patients with LR reported greater anxiety, depression, and increased pain following surgery. Spirituality was associated with an increase in resilience over the year following surgery, whereas having never being married was associated with a decrease in resilience following surgery while controlling for other factors. Our study, for the first time, identifies a potential avenue for improved recovery after cardiac surgery by supporting resilience and spirituality in the perioperative period. In this era of increased emphasis on “enhanced recovery after surgery” programs, this provides another mode for enhancing patient recovery, perhaps by including optional spiritual interventions after surgery. Assessing for and including spirituality may facilitate patients’ retrieval of preexisting coping mechanisms (e.g., faith practices, meditation, etc.). Our results, combined with precedent literature that outlines the mental and physical health benefits associated with resilience and spirituality, highlight the need for further examination in this area. Supporting spirituality in the perioperative surgery process may increase resilience and have positive downstream effects in improving cardiac patients’ mental and physical health.
Funding Statement
This work was supported by a grant from the Baylor Heart and Vascular Institute Cardiovascular Research Review Committee.
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