|
|
Back to 2014 Annual Meeting Abstracts
Peri-Operative Patient Reported Outcomes Predict Serious Surgical Complications
Juliane Bingener*1, Jeff Sloan3, Paul Novotny3, Barbara a. Pockaj2, Heidi Nelson4
1Division of General Surgery, Mayo Clinic - Rochester, Rochester, MN; 2Surgery, Mayo Clinic, Scottsdale, AZ; 3Health Sciences Research, Mayo Clinic, Rochester, MN; 4Surgery, Mayo Clinic, Rochester, MN
Background: Decreased survival after colon cancer surgery has been reported in patients with deficient baseline quality-of-life (QOL) as described in a recent secondary analysis of the COST(Clinical Outcomes of Surgical Therapy) trial. We hypothesized that deficits in baseline QOL are also associated with postoperative complications.
Patients and methods: A secondary analysis of the COST trial 93-46-53 (INT 0146) was performed. Patient demographics, surgical complications (grade 0-4), composite and single item QOL scores were used for univariate and multivariate analysis. QOL deficit was defined as an overall QOL score <50 on a 100 point scale. Early changes in QOL were defined as changes from baseline to postoperative day 2 or day 14 (POD2 POD14). 416 patients provided the power to identify + 5 points (0.5 standard deviation [STD]) difference in the global QOL scale with a 95% confidence interval.
Results: Of the 431 patients who were enrolled in the QOL portion of the COST trial, 81 patients (19%) experienced complications prior to discharge. Of these, 42 complications (7%) were serious (grade 2-4) including two deaths (0.5%). Eighty-nine patients (24%) experienced late complications within 2 months of the operation, including readmission.
55 patients (13%) had a QOL score < 50 at baseline. Patients with a baseline QOL deficit were more likely to have a serious early complication than patients without a QOL deficit (16 vs 6%, p=0.0234). Patients who experienced early complications reported worse ‘appearance' (0.25 STD, p=0.0126), and worsening breathing (0.3 STD, p=0.033) on postoperative day 2.
Patients with an early complication were 3 years older (p=0.03) and more likely ASA III (p=0.0034). Gender, race, tumor stage and laparoscopic or open approach were not associated with an increased frequency of complications. Patients with complications experienced a 3.5 day longer hospital stay (p=0.0001). After adjusting for age, gender, race, tumor stage, ASA and operative approach, significant predictors for being readmitted to the hospital were baseline pain distress (OR 1.61, CI 1.11-2.34, p=0.0125), changes from baseline to day 2 in fatigue (OR 1.34 CI 1.03-1.74, p=0.032) and from baseline to postoperative day 14 in activity (OR 1.56 CI 1.07-2.29, p=0.0225), daily living (OR 2.08, CI1.23-3.51, p= 0.0063) and outlook (OR 2.78, CI 1.19-6.53, p=0.0187).
Discussion: The QOL assessment was initially included in the COST trial to compare two surgical approaches for their impact on the patient. Together with other reports this study suggests that QOL tools also can provide an early indicator for patients at risk of complications. Further studies are needed to evaluate whether perioperative assessment of QOL may assist in reducing postoperative complications, length of hospital stay and readmission.
Back to 2014 Annual Meeting Abstracts
|
