A prognostic model for assessing the risk of psychosocial adaptation in patients who have undergone cardiosurgical interventions

Abstract

The purpose of the study is to develop a prognostic model for assessing the risk of psychosocial maladjustment (PSM) in pa- tients who have undergone cardiosurgi- cal interventions (CI), taking into account a complex of surgical, neurological and psychopathological factors. 700 patients were examined after they underwent CI with an artificial blood circu- lation procedure: 86 patients with cerebral infarction, 217 patients with signs of post- operative encephalopathy and 504 patients with manifestations of cognitive dysfunction. For creating the model, non-linear modeling methods were used (multiple linear regres- sion analysis with a linearized model). Based on the research data, we pro- posed a complex model of PSM taking into account clinical, phenomenologi- cal and psychosocial factors. The model is based on a comprehensive assessment of three key vectors that can exert influence on the course of the postoperative period and the formation of PSM. The first vector (“surgical”) includes the main factors that characterize the seve- rity of the surgical intervention, and which have the greatest impact on the course of the postoperative period. The quantifica- tion of this vector is based on the following indicators: the duration, body temperature and blood pressure during surgery. The second vector (“neurological”) takes into account the main ischemic and neuro- logical complications in the postoperative period: cerebral infarction, postoperative encephalopathy, and postoperative cogni- tive dysfunction. The quantitative assess- ment of this vector is based on the results of the study of the patient’s cognitive function in the early postoperative period, namely, the indicators of the TMT-A and TMT-B tests, and the Stroop test. The third vector (“psychopathological”) includes three main psychopathological disorders: depression, anxiety, and aggres- siveness, and its quantification is based on the integral indicators of depression and anxiety according to the depression and anxiety scales of M. Hamilton and indicators of aggressiveness and hostility according to the Bass-Darkie test. The proposed model makes it pos- sible to obtain informative predictive indi- cators of PSM, which are close to the va- lues obtained by the diagnostic method of socio-psychological adaptation C. Rogers & R. F. Dymond in the modification of A. K. Osnytsky