Division of Trauma, Critical Care and Acute Care Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas.
Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, Texas.
Ann Thorac Surg. 2021 Jun;111(6):1954-1960. doi: 10.1016/j.athoracsur.2020.07.063. Epub 2020 Oct 13.
Quality of life (QoL) is increasingly important in the era of patient-centered outcomes and value-based reimbursement. However most follow-up is limited to 30 days, and long-term data on QoL improvement associated with symptom relief are lacking. Therefore we sought to analyze QoL after cardiac surgery in a nonemergent, all-comers population.
Four hundred two patients undergoing routine cardiac surgery at 2 large urban hospitals in the Dallas, Texas area were enrolled. Follow-up was complete for 364 patients. Data were collected from August 2013 to January 2017. The Kansas City Cardiomyopathy Questionnaire was administered at baseline, 1 month, and 1 year after surgery. Repeated-measures analysis was used for each domain of the questionnaire for all procedures and stratified by procedure. If time was found to be a significant factor, pairwise analysis was performed with P values adjusted using the Tukey-Kramer method.
There was a significant increase across all domains of Kansas City Cardiomyopathy Questionnaire scores for all procedures and for most domains when stratifying by procedure. This increase in QoL was most marked after 1 month. All domain scores increased through 1 year except symptom stability, which peaked at 1 month postsurgery and then regressed at 1 year, suggesting an overall improvement and stabilization of symptoms. The occurrence of complications did not alter this trajectory.
QoL and other patient-centered outcomes are improved at 1 month and continue to improve throughout the year. Knowledge of these data is important for patient selection, fully informed consent, and shared decision-making.
在以患者为中心的结果和基于价值的报销时代,生活质量(QoL)变得越来越重要。然而,大多数随访时间仅限于 30 天,缺乏与症状缓解相关的 QoL 改善的长期数据。因此,我们试图分析在达拉斯德克萨斯州两个大城市医院进行常规心脏手术的非紧急、所有患者人群的 QoL。
在达拉斯德克萨斯州的 2 家大型城市医院进行常规心脏手术的 402 例患者被纳入研究。364 例患者完成了随访。数据收集时间为 2013 年 8 月至 2017 年 1 月。在手术前、手术后 1 个月和 1 年后,采用堪萨斯城心肌病问卷对所有患者进行了评估。对问卷的每个领域进行了重复测量分析,对于所有手术和按手术分层的分析。如果时间是一个显著因素,则使用 Tukey-Kramer 方法调整 P 值进行两两分析。
对于所有手术和按手术分层的大多数领域,堪萨斯城心肌病问卷评分的所有领域都有显著增加。这种 QoL 的增加在手术后 1 个月最为明显。除症状稳定性外,所有领域的评分在 1 年内都有所增加,症状稳定性在手术后 1 个月达到峰值,然后在 1 年内下降,这表明症状整体改善和稳定。并发症的发生并没有改变这种轨迹。
1 个月时 QoL 和其他以患者为中心的结果得到改善,并在整个年度继续改善。了解这些数据对于患者选择、充分知情同意和共同决策非常重要。