Sato Mariko, Ida Mitsuru, Naito Yusuke, Kawaguchi Masahiko
Department of Anesthesiology, Takatsuki General Hospital, Takatsuki, Japan.
Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
JA Clin Rep. 2023 Feb 6;9(1):4. doi: 10.1186/s40981-023-00598-9.
Postoperative death is the third leading cause of death in the world, but the quality of death after surgery has been poorly documented. This study aimed to evaluate the feasibility of a questionnaire survey for the bereaved family regarding the postoperative quality of death and the impact of preoperative functional disability on the quality of death.
Patients aged ≥55 years who underwent scheduled surgery under general anesthesia in a tertiary-care hospital in Japan between April 2016 and December 2018 were enrolled. Patients' functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) before surgery and scored based on the sum of the 12 items (0-48). Postoperative deaths were detected in medical records 3 months and 1 year after surgery. When death had occurred, a questionnaire on the quality of death using the short version of the Good Death Inventory (GDI) was sent to the bereaved family, which was scored as the sum of the 10 domains (10-70).
Of 4020 eligible patients, 148 patients (3.6 %) died within 1 year after surgery. A hundred and twenty-nine bereaved families were sent the questionnaire, and 83 of them (64.3%) submitted valid responses suggesting the high feasibility of this questionnaire survey. There were no differences between the GDI and WHODAS 2.0 scores (median 49 [interquartile range 41-55] vs. 49 [43-54], respectively, p = 0.90). In addition, multiple regression analysis of related factors using the short version of the GDI as a continuous variable showed that age and death in a facility other than that in which the surgery was performed were associated with lower GDI scores (p = 0.004 and p = 0.04, respectively).
The completion rate was 64.3%. There was no association between the quality of death and preoperative functional disability; however, older age was associated with a higher quality of death, while death in a facility other than that in which the surgery was performed was associated with lower quality of death.
术后死亡是全球第三大死因，但术后死亡质量的记录却很不完善。本研究旨在评估针对死者家属进行问卷调查以了解术后死亡质量以及术前功能残疾对死亡质量影响的可行性。
纳入2016年4月至2018年12月期间在日本一家三级医院接受全身麻醉下择期手术的年龄≥55岁的患者。术前使用12项世界卫生组织残疾评定量表2.0（WHODAS 2.0）评估患者的功能残疾情况，并根据12项得分总和（0 - 48分）进行评分。术后3个月和1年在病历中检测术后死亡情况。当患者死亡时，向其家属发送一份使用简化版善终量表（GDI）的关于死亡质量的问卷，该问卷根据10个领域的得分总和（10 - 70分）进行评分。
在4020名符合条件的患者中，148名患者（3.6%）在术后1年内死亡。向129名死者家属发送了问卷，其中83名（64.3%）提交了有效回复，表明该问卷调查具有较高的可行性。GDI得分与WHODAS 2.0得分之间无差异（中位数分别为49[四分位间距41 - 55]和49[43 - 54]，p = 0.90）。此外，将简化版GDI作为连续变量对相关因素进行多元回归分析显示，年龄以及在手术实施机构以外的其他机构死亡与较低的GDI得分相关（分别为p = 0.004和p = 0.04）。
完成率为64.3%。死亡质量与术前功能残疾之间无关联；然而，年龄较大与较高的死亡质量相关，而在手术实施机构以外的其他机构死亡与较低的死亡质量相关。
