EARLY POST-OPERATIVE PAIN AND FATIGUE ARE PREDICTIVE OF MAJOR COMPLICATIONS IN THE FIRST 30 DAYS AFTER SURGERY
Hind Al-Lami1, Cornelius A. Thiels1, Pamela E. Skaran1, Kristine Hanson*2, Juliane Bingener1
1Surgery, Mayo Clinic, Rochester, MN; 2Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
Introduction:
Pre-operative patients reported outcomes are predictive of hospital readmission in surgical patients. Quality of life deficit correlated with worse survival outcomes in cancer patients. In this study, we examined the effect of overall quality of life, pain, and fatigue reported by the patients pre-operatively (Pre-op) and on the second day after surgery (POD-2) on the occurrence of major complications in the first 30 days after surgery.
Methods:
To examine the correlation between early perioperative patient reported outcomes and postoperative complications we conducted a prospective study of patients undergoing major gastrointestinal surgeries. We measured patient reported outcomes before and at second, 7th, 14th and 30th days after surgery using overall quality of life (OQL), fatigue and pain items from a validated linear analog self-assessment scale. OQL of 5 or less was classified as poor OQL, pain severity of 5 or more was classified as severe pain, and fatigue level of 7 or more was classified as severe fatigue. Thirty-day complications with Clavien Dindo class three or more were classified as major. We conducted univariate and multivariate analyses using JMP PRO. We controlled for surgical procedure performed, and American Society of Anesthesiologists score.
Results:
A total of 340 patients who underwent open or minimally invasive colectomy (45%), pancreaticoduodenectomy (37%), proctectomy (12%), or esophagectomy (6%) were included in the analysis. Our sample is 44% women, and has mean age of 58 years. In regard to American Society of Anesthesiologists score, 56% had score of three or 4. In regard to patient reported outcomes, 13%, and 35% had poor OQL, 26% and 52% had severe pain, 22% and 38% had severe fatigue Pre-Op and on POD-2, respectively. By day 30 post-operatively, 49% of cases had not experienced any complications, 33% had mild complications, and 18% had major complications. Patients with severe pain on POD-2 had almost two folds the odds of developing severe complications in the first 30 days after surgery (univariate: odds ratio= 1.90, p=0.03, multivariate: odds ratio=1.93, p=0.04). Although not statistically significant, patients with severe fatigue on POD-2 had 1.71 higher odds of complications compared to no/mild fatigue group (p=0.06). Pre-Op OQL, pain, and fatigue, and POD-2 OQL were not significantly associated with major post-operative complications.Type of procedure performed was the only other significant predictor of 30-days post-operative complications.
Conclusion:
Pain and fatigue in the early post-operative period are significant tools to predict complications after surgery such as surgical site infection, bleeding, cardiac, and respiratory complications. Patient reported outcomes can be used to further guide post-operative care and patients follow up.
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