Waljee Jennifer F, Ghaferi Amir, Cassidy Ruth, Varban Oliver, Finks Jonathan, Chung Kevin C, Carlozzi Noelle E, Dimick Justin B
*Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI †Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI ‡Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI §Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI ¶Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI ||Department of Surgery, University of Michigan, Ann Arbor, MI **Center for Clinical Outcomes Development and Application, Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI ††Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI.
Ann Surg. 2016 Oct;264(4):682-9. doi: 10.1097/SLA.0000000000001852.
To evaluate the extent to which patient-reported outcomes (PROs) (eg, health-related quality of life) are distinct from clinical outcomes following bariatric surgery.
Hospital quality measurement often focuses on traditional clinical outcomes (eg, complications). However, PROs may provide a unique perspective regarding performance, particularly for common, low-risk procedures.
We used data from 11,420 patients who underwent bariatric surgery (2008-2012) from the Michigan Bariatric Surgery Collaborative (39 hospitals). We included both short-term (30-day complication rates) and long-term (1-year weight loss and comorbidity resolution) outcomes. For PROs, we used health-related quality of life assessed by the Health and Activities Limitations Index (HALex) and Bariatric Quality of Life (BQL) index preoperatively and at 1 year. We used multivariable linear regression to determine the association between these PROs and both short and long-term clinical outcomes, adjusting for patient factors and the type of surgical procedure.
After adjustment for risk factors and surgical procedure, hospital rankings based on PROs (either the average change in HALex or BQL scores) were not correlated with hospital rankings based on complications. In contrast, both PRO measures were correlated with weight loss. Specifically, the average change in HALex score (R = 0.24, P < 0.002) and average change in BQL score (R = 0.44, P < 0.001) were correlated with hospital average percent excess. One PRO measure-BQL score-was correlated with a decline in the need for medications due to associated comorbidities (R = 0.16, P < 0.01). After accounting for short and long-term clinical outcomes, between 15% and 44% of the variation in PROs remained unexplained at the hospital level.
Patient-reported outcomes are not correlated with early perioperative events, but are correlated with measures of clinical effectiveness after bariatric surgery. A comprehensive approach to surgical quality should incorporate both clinical events and self-reported measures of health status throughout the short and long-term recovery period.
评估减肥手术后患者报告结局（PROs）（如健康相关生活质量）与临床结局的不同程度。
医院质量评估通常侧重于传统临床结局（如并发症）。然而，PROs可能会提供有关手术表现的独特视角，特别是对于常见的低风险手术。
我们使用了来自密歇根减肥手术协作组（39家医院）的11420例接受减肥手术患者（2008 - 2012年）的数据。我们纳入了短期（30天并发症发生率）和长期（1年体重减轻和合并症缓解情况）结局。对于PROs，我们使用术前和术后1年通过健康与活动受限指数（HALex）和减肥生活质量（BQL）指数评估的健康相关生活质量。我们使用多变量线性回归来确定这些PROs与短期和长期临床结局之间的关联，并对患者因素和手术类型进行了调整。
在对风险因素和手术类型进行调整后，基于PROs（HALex或BQL评分的平均变化）的医院排名与基于并发症的医院排名不相关。相比之下，两种PRO测量指标均与体重减轻相关。具体而言，HALex评分的平均变化（R = 0.24，P < 0.002）和BQL评分的平均变化（R = 0.44，P < 0.001）与医院平均超重百分比相关。一项PRO测量指标——BQL评分——与因相关合并症导致的药物需求减少相关（R = 0.16，P < 0.01）。在考虑短期和长期临床结局后，医院层面PROs中15%至44%的变异仍无法解释。
患者报告结局与围手术期早期事件无关，但与减肥手术后的临床疗效指标相关。手术质量的综合评估方法应在短期和长期恢复期纳入临床事件和自我报告的健康状况指标。
