Gordeev Vladimir Sergeevich, Assefa Esubalew, Pearse Rupert, Edwards Mark, Mihaylova Borislava
Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
World J Emerg Surg. 2025 Sep 2;20(1):73. doi: 10.1186/s13017-025-00643-1.
Patients' survival and quality of life are key factors in assessing value of treatments. However, limited evidence exists about the trajectory and key determinants of patients' health-related quality of life (QoL) following emergency abdominal surgery.
Using the Enhanced Peri-Operative Care for High-risk patients study with measured QoL during eight months follow-up using the EQ-5D-3L questionnaire, we summarise the trajectory of patients' QoL after emergency abdominal surgery and use multivariable regression models to relate patients' demographic and clinical characteristics, pre-surgery characteristics, and time elapsed since surgery with their QoL. In further analysis we assess the contribution of post-surgery patient characteristics.
Data from 686 patients undergoing emergency abdominal surgery (50.4% female; mean age 66.6 (standard deviation (SD) 12.8) years; 50.1% with intestinal obstruction as indication for surgery), with QoL measurements were analysed. Shortly after surgery (mean days 7.59 (SD 7.48)), the mean EQ-5D-3L QoL utility score was 0.21 (SD 0.46), which improved among survivors to 0.74 (SD 0.31) in the medium- to long-term (i.e., three to eight months) following surgery. Patient's sex and preoperative risk of mortality were key determinants of QoL shortly after surgery. In addition to time since surgery, patient's sex, Charlson Comorbidity index, ASA physical status and indication for surgery were key pre-surgery predictors of QoL in the medium- to long-term post-surgery. From post-surgery characteristics, duration of hospital admission for index surgery and further days in hospital within 30 days prior to QoL measurement were key further determinants of QoL in the medium- to long-term.
Individual patient, surgery, and recovery characteristics determine QoL post-emergency abdominal surgery and can help inform clinician-patient discussions and assessments of value of abdominal surgery interventions.
患者的生存和生活质量是评估治疗价值的关键因素。然而，关于急诊腹部手术后患者健康相关生活质量（QoL）的轨迹和关键决定因素的证据有限。
利用针对高危患者的强化围手术期护理研究，在八个月的随访期间使用EQ-5D-3L问卷测量QoL，我们总结了急诊腹部手术后患者QoL的轨迹，并使用多变量回归模型将患者的人口统计学和临床特征、术前特征以及手术以来的时间与他们的QoL联系起来。在进一步分析中，我们评估术后患者特征的作用。
分析了686例接受急诊腹部手术患者的数据（50.4%为女性；平均年龄66.6（标准差（SD）12.8）岁；50.1%以肠梗阻作为手术指征），并进行了QoL测量。术后不久（平均7.59（SD 7.48）天），平均EQ-5D-3L QoL效用评分为0.21（SD 0.46），在幸存者中，术后中长期（即三至八个月）改善至0.74（SD 0.31）。患者的性别和术前死亡风险是术后不久QoL的关键决定因素。除了手术时间外，患者的性别、Charlson合并症指数、ASA身体状况和手术指征是术后中长期QoL的关键术前预测因素。从术后特征来看，首次手术的住院时间和QoL测量前30天内的进一步住院天数是术后中长期QoL的关键进一步决定因素。
个体患者、手术和恢复特征决定了急诊腹部手术后的QoL，并有助于为临床医生与患者的讨论以及腹部手术干预价值的评估提供信息。
