Grigor Emma J M, Ivanovic Jelena, Anstee Caitlin, Zhang Zach, Gilbert Sebastian, Maziak Donna E, Shamji Farid M, Sundaresan Sudhir, Villeneuve Patrick J, Ramsay Tim, Seely Andrew J E
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Ann Thorac Surg. 2017 Aug;104(2):382-388. doi: 10.1016/j.athoracsur.2017.05.025. Epub 2017 Jun 29.
Postoperative adverse events (AEs), prolonged length of stay (PLOS), and patient experience are common quality measures after thoracic surgical procedures. Our objective was to investigate the relationship of postoperative AEs on patient experience and hospital length of stay (LOS) after lung cancer resection.
AEs (using Thoracic Morbidity and Mortality system based on Clavien-Dindo schema) and LOS were prospectively collected for all patients undergoing lung cancer resection. A 21-item questionnaire, retrospectively asking about patient experience, was mailed to patients twice (October 2015 and January 2016). The impact of AEs on experience was investigated and stratified by hospital LOS, with PLOS defined as the 75th percentile. Univariate analysis used parametric (t test) and nonparametric (Mann-Whitney) tests according to test conditions.
Of 288 patients who responded to the survey (70% response rate), 175 (61%) had no AEs, 113 (39%) had experienced at least one AE, and 52 (18%) had experienced PLOS. Lung cancer patients who experienced PLOS showed significantly decreased experience on several questionnaire items, including their impression of comprehensiveness of surgeons information provision during inpatient period (p = 0.008), inpatient recovery from operation (p = 0.001), quality of life 30 days after operation (p = 0.032), follow-up care, (p = 0.022), and satisfaction with outcome 1 year after operation during follow-up care (p = 0.022). The presence of postoperative AEs led only to reduced impression about inpatient recovery from the operation (p = 0.01).
In this cohort, postoperative AEs were minimally associated with negative patient experience. However, patients who experienced PLOS demonstrated a marked reduction in experience after thoracic surgical procedures.
术后不良事件（AE）、住院时间延长（PLOS）和患者体验是胸外科手术后常见的质量指标。我们的目的是研究肺癌切除术后AE与患者体验及住院时间（LOS）之间的关系。
前瞻性收集所有接受肺癌切除术患者的AE（使用基于Clavien-Dindo分类法的胸科发病率和死亡率系统）和LOS。一份回顾性询问患者体验的21项问卷分两次邮寄给患者（2015年10月和2016年1月）。研究AE对体验的影响，并按住院LOS分层，PLOS定义为第75百分位数。单因素分析根据测试条件使用参数检验（t检验）和非参数检验（Mann-Whitney检验）。
在288名回复调查的患者中（回复率70%），175名（61%）无AE，113名（39%）至少经历过一次AE，52名（18%）经历过PLOS。经历过PLOS的肺癌患者在几个问卷项目上的体验显著下降，包括他们对住院期间外科医生信息提供全面性的印象（p = 0.008）、术后住院恢复情况（p = 0.001）、术后30天的生活质量（p = 0.032）、后续护理（p = 0.022）以及随访期间术后1年对手术结果的满意度（p = 0.022）。术后AE的出现仅导致对术后住院恢复的印象降低（p = 0.01）。
在该队列中，术后AE与负面患者体验的关联极小。然而，经历过PLOS的患者在胸外科手术后体验明显下降。
