Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Kieran Fogarty

Second Advisor

Dr. David Barker

Third Advisor

Dr. Mark Marbey

Fourth Advisor

Dr. Eric Vangsnes


Functional status, cardiac risk scores, elective open heart surgery, quality of life, postoperative mortality and, morbidity


The very nature of mortality and morbidity surrounding cardiac surgery is complex with numerous risk factors involved and researchers have found functional status to be a stronger predictor of outcomes than the admitting diagnosis. Preoperative functional status, however, is not measured by any of the cardiac risk scores. Functional status can be objectively measured using validated outcome tools such as the Late-Life Function and Disability Instrument (LLFDI). In 3 studies, the impact and association of functional status changes over time was explored in patients who have undergone elective open heart surgery. Analyses in Study 1 demonstrated significantly improved functional status from preoperative to one year postoperative, both in performing routine tasks and in participating more frequently in social activities (components of LLFDI). With a strong influencing covariate, social support (or lack thereof), there appears to be a direct relationship between functional status and perceived quality of life (Study 2). Preoperative diminished functional status, as measured by the LLFDI, is associated with an increased risk of mortality and morbidity in patients undergoing elective cardiac surgery (Study 3). These findings suggest that careful consideration of all the risks and benefits of cardiac surgery should also include a patient’s preoperative functional status, especially in the case of an elective procedure. For patients, this may better assist them in what to expect for recovery so they can make a more informed decision.

Access Setting

Dissertation-Open Access