Downey Candice L, Bainbridge Jamie, Jayne David G, Meads David M
Leeds Institute of Medical Research at St James's, Clinical Sciences Building, St James's University Hospital, University of Leeds, Leeds, UK.
Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK.
Br J Surg. 2023 Aug 11;110(9):1206-1212. doi: 10.1093/bjs/znad167.
Postoperative complications are common, but there are limited data regarding their implications on patients' quality of life. This study aimed to address this gap in the literature by analysing the impact of postoperative complications on patients' health-related quality of life.
Data from the Perioperative Quality Improvement Programme were analysed, and included patient-level data for 19 685 adults who underwent elective major abdominal procedures in England since 2016. Postoperative complications were graded using the Clavien-Dindo classification. Quality of life was assessed by responses to the EuroQol five-dimension five-levels-of-response (EQ-5D-5L™) questionnaire before surgery, and at 6 and 12 months after operation. Ordinal logistic regression was used to estimate the association between Clavien-Dindo grades and quality of life. Tobit and ordinary least squares regression analyses were used to estimate the quality-adjusted life-year (QALY) loss resulting from postoperative complications between admission and 12 months after surgery.
At 6 and 12 months after surgery, increasingly severe postoperative complications were significantly associated with poorer health-related quality of life. The effect of postoperative complications on quality of life was sustained until at least 12 months after operation. Between admission and 12 months after surgery, 0.012, 0.026, 0.033, and 0.086 QALYs were lost for those experiencing a grade I, II, III, or IV postoperative complication respectively.
Postoperative complications have a significant and sustained effect on patients' quality of life after surgery; this effect worsens as the severity of the complications increases.
术后并发症很常见，但关于其对患者生活质量影响的数据有限。本研究旨在通过分析术后并发症对患者健康相关生活质量的影响来填补这一文献空白。
分析了围手术期质量改进计划的数据，包括自2016年以来在英格兰接受择期腹部大手术的19685名成年人的患者层面数据。术后并发症采用Clavien-Dindo分类法分级。在手术前、术后6个月和12个月，通过对欧洲五维健康量表（EQ-5D-5L™）问卷的回答来评估生活质量。采用有序逻辑回归估计Clavien-Dindo分级与生活质量之间的关联。采用托比特回归和普通最小二乘回归分析估计术后并发症在入院至术后12个月期间导致的质量调整生命年（QALY）损失。
在术后6个月和12个月，术后并发症越严重，与健康相关生活质量越差显著相关。术后并发症对生活质量的影响至少持续到术后12个月。在入院至术后12个月期间，经历I级、II级、III级或IV级术后并发症的患者分别损失0.012、0.026、0.033和0.086个QALY。
术后并发症对患者术后生活质量有显著且持续的影响；随着并发症严重程度的增加，这种影响会加剧。
