Health-related quality of life pre-war and during-war in cardiac patients: evidence from a multicenter prospective study - West Bank.

BACKGROUND

War imposes systemic and psychosocial stressors that can disrupt postoperative recovery and diminish quality of life. Quantitative data examining these effects in cardiac surgery populations remain scarce.

OBJECTIVES

To assess whether the wartime period following October 7, 2023, independently affected postoperative health-related quality of life (HRQoL) among patients undergoing coronary artery bypass grafting (CABG) or valve surgery in Palestine.

METHODS

In this prospective multicenter cohort, 1,686 patients who underwent cardiac surgery between September 2022 and May 2025 were screened. After exclusion of 486 ineligible or non-followed participants, 1,200 patients were included: 465 operated pre-war and 735 during-war. HRQoL was evaluated using the 12-Item Short-Form Health Survey (SF-12), generating Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores. Associations between wartime exposure and SF-12 outcomes were analyzed using generalized linear models (GLMs) with robust standard errors and validated through propensity score matching (PSM, 1:1 nearest neighbor) matching on age, gender, diabetes, surgery type, cardiopulmonary bypass time, and hospital fixed effects.

RESULTS

Open-heart procedures increased by 5% monthly during-war. Postoperative complications were generally more frequent in this period, with notable rises in acute kidney injury (33.8% vs. 22.4%), atrial fibrillation (31.9% vs. 24.8%), and surgical site infection (8.8% vs. 4.1%). Mean PCS and MCS values were significantly lower during-war (p = 0.037 and p = 0.013, respectively). In adjusted GLMs, wartime exposure remained independently associated with reduced HRQoL (β = − 1.31 [95% CI − 3.27 to − 0.65] for PCS; β = − 1.19 [95% CI − 3.12 to − 0.75] for MCS). PSM confirmed these findings (PCS = − 1.47 [95% CI − 2.89 to − 0.06], p = 0.041; MCS = − 1.82 [95% CI − 3.67 to 0.04], p = 0.056).

CONCLUSIONS

Wartime conditions were independently associated with clinically relevant reductions in both physical and mental postoperative quality of life. Sustained access to rehabilitation, psychosocial support, and follow-up care is crucial to preserving recovery among cardiac surgery patients in conflict-affected settings. CLINICAL TRIAL NUMBER: Not applicable.