Antonescu Ioana, Carli Francesco, Mayo Nancy E, Feldman Liane S
Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9.300, Montreal, QC, H3G 1A4, Canada,
Surg Endosc. 2014 Nov;28(11):3168-78. doi: 10.1007/s00464-014-3577-8. Epub 2014 May 31.
Surgery is evolving, and new techniques are introduced to improve "recovery." Postoperative recovery is complex, and evaluating the effectiveness of surgical innovations requires assessment of patient-reported outcomes. The Short-Form-36 (SF-36), a generic health-related quality of life questionnaire, is the most commonly used instrument in this context. The objective of this study was to contribute evidence for the validity of the SF-36 as a metric of postoperative recovery.
Data from 128 patients undergoing planned colorectal surgery at one university hospital between 2005 and 2010 were analyzed. In the absence of a gold standard, the responsiveness and construct validity (known groups and convergent) of the SF-36 were evaluated. Standardized response means were computed for the former and non-parametric tests were used to assess the statistical significance of the changes observed. Multiple linear regression was used to determine whether the SF-36 discriminates between patients with versus without complications and between laparoscopic and open surgery (known groups); correlations between the SF-36 and the 6-min walk test, a measure of functional walking capacity (convergent) was investigated with Spearman's rank correlation.
The SF-36 was sensitive to clinically important changes. Scores on six of eight domains and the physical component summary score deteriorated postoperatively (SRM 0.86 for the PCS, p < 0.01) and improved to baseline thereafter. Patients with complications had significantly lower scores on five SF-36 domains (with differences from -9 (-18, -1), p = 0.04 to -18 (-32, -2), p = 0.03), and scores on all subscales were lower than those in a healthy population (p < 0.01 to p = 0.04). The SF-36 did not differentiate between laparoscopic and open surgery. Physical functioning scores correlated with 6MWT distance at 1 and 2 months (Spearman's r = 0.31 and 0.36, p < 0.01).
The SF-36 is responsive to expected physiological changes in the postoperative period, demonstrates construct validity, and thus constitutes a valid measure of postoperative recovery after planned colorectal surgery. The SF-36 did not, however, discriminate between recovery after laparoscopic and open surgery.
外科手术在不断发展，新的技术被引入以改善“恢复情况”。术后恢复是一个复杂的过程，评估手术创新的有效性需要对患者报告的结果进行评估。简明健康状况调查问卷（SF - 36）是一种通用的与健康相关的生活质量问卷，是在此背景下最常用的工具。本研究的目的是为SF - 36作为术后恢复指标的有效性提供证据。
分析了2005年至2010年期间在一家大学医院接受计划性结直肠手术的128例患者的数据。在缺乏金标准的情况下，对SF - 36的反应性和结构效度（已知组和收敛效度）进行了评估。计算了前者的标准化反应均值，并使用非参数检验来评估观察到的变化的统计学意义。使用多元线性回归来确定SF - 36是否能区分有并发症和无并发症的患者以及腹腔镜手术和开放手术患者（已知组）；通过Spearman等级相关性研究了SF - 36与6分钟步行试验（一种功能性步行能力的测量方法）之间的相关性（收敛效度）。
SF - 36对临床上重要的变化敏感。八个领域中的六个领域以及身体成分总结得分在术后下降（PCS的SRM为0.86，p < 0.01），此后恢复到基线水平。有并发症的患者在五个SF - 36领域的得分显著较低（差异从 - 9（-18，-1），p = 0.04到 - 18（-32，-2），p = 0.03），并且所有子量表的得分均低于健康人群（p < 0.01至p = 0.04）。SF - 36不能区分腹腔镜手术和开放手术。身体功能得分在1个月和2个月时与6分钟步行试验距离相关（Spearman's r = 0.31和0.36，p < 0.01）。
SF - 36对术后预期的生理变化有反应，具有结构效度，因此是计划性结直肠手术后术后恢复的有效测量指标。然而，SF - 36不能区分腹腔镜手术和开放手术后的恢复情况。
