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Prospective longitudinal cohort study of patient recovery after major gastrointestinal surgery: is there a difference between minimally invasive and open approaches?

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Surgeons use the absence of post-operative complications to define recovery while patients define recovery as return to normal function. We aimed to better define the recovery process after minimally invasive surgery (MIS) and open gastrointestinal surgery.

Methods

Patients scheduled for open or MIS pancreaticoduodenectomy, esophagectomy, colectomy, and proctectomy were prospectively enrolled. Patient-reported outcomes (PROs) were collected using validated PROMIS and LASA scales pre-operatively, on post-operative days 2, 7, 14, 30, and monthly until 6 months. Patients were also asked if they felt fully recovered. Descriptive statistics and area under the curve (AUC) were used to compare approaches. Multivariable mixed-effects repeated measures models and logistic regression were used to control for covariates.

Results

340 patients met inclusion criteria (158 open and 182 MIS). Median age was 60 years with 44% women. The PRO showed improved post-operative QOL scores in MIS compared to open on all measures by AUC. None of these difference persisted at 6-months. After adjusting for covariates, MIS had higher overall QOL scores at day 14 (Estimate + 0.58, p = 0.02) and 30 (+ 0.56, p = 0.03). Differences did not persist at 3 and 6 months (both p > 0.05). At 1, 3, and 6 months, 20%, 47%, and 61% of patients reported feeling completely recovered. On adjusted analysis there was no difference in odds of complete recovery in MIS at 1 (OR 1.07 [95% CI 0.53–2.14] and 3 months (1.12 [0.63–2.01]) compared to open. MIS patients were more likely to report complete recovery at 6 months (1.87 [1.05–3.33]).

Conclusion

MIS patients reported improved PRO on selected QOL measures early in the recovery period compared to open. There was no difference in long-term QOL data between MIS and open patients. Two-thirds (61%) of patients reported being fully recovered at 6 months with MIS patients being more likely to report a complete recovery.

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References

  1. Detsky AS (2011) What patients really want from health care. JAMA 306:2500–2501

    CAS  PubMed  Google Scholar 

  2. Lee L, Tran T, Mayo NE, Carli F, Feldman LS (2014) What does it really mean to “recover” from an operation? Surgery. 155:211–216

    Article  Google Scholar 

  3. Nguyen NT, Nguyen B, Shih A, Smith B, Hohmann S (2013) Use of laparoscopy in general surgical operations at academic centers. Surg Obes Relat Dis 9:15–20

    Article  Google Scholar 

  4. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  5. Rizk NP, Ghanie A, Hsu M, Bains MS, Downey RJ, Sarkaria IS, Finley DJ, Adusumilli PS, Huang J, Sima CS, Burkhalter JE, Park BJ, Rusch VW (2014) A prospective trial comparing pain and quality of life measures after anatomic lung resection using thoracoscopy or thoracotomy. Ann Thorac Surg 98:1160–1166

    Article  Google Scholar 

  6. Barbour AP, Cormack OMM, Baker PJ, Hirst J, Krause L, Brosda S, Thomas JM, Blazeby JM, Thomson IG, Gotley DC, Smithers BM (2017) Long-term health-related quality of life following esophagectomy. Ann Surg 265:1158–1165

    Article  Google Scholar 

  7. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, Clinical Outcomes of Surgical Therapy (COST) Study Group (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328

    Article  Google Scholar 

  8. PROMIS, Am. Institutes Res. (2011). http://nihpromis.org/ Accessed 5 Apr 2019

  9. PCORI Approves $5 Million to Fund Methods Research with PROMIS, Patient-Centered Outcomes Res. Inst. (2014). http://www.pcori.org/news-release/pcori-approves-5-million-fund-methods-research-promis®. Accessed 5 Apr 2019

  10. Sloan JA, Aaronson N, Cappelleri JC, Fairclough DL, Varricchio C (2002) Assessing the clinical significance of single items relative to summated scores. Mayo Clin Proc 77:479–487

    Article  Google Scholar 

  11. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  CAS  Google Scholar 

  12. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  13. Mondloch MV, Cole DC, Frank JW (2001) Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ 165:174–179

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Merchea A, Lovely JK, Jacob AK, Colibaseanu DT, Kelley SR, Mathis KL, Spears GM, Huebner M, Larson DW (2018) Efficacy and outcomes of intrathecal analgesia as part of an enhanced recovery pathway in colon and rectal surgical patients. Surg Res Pract 2018:1–5

    Article  Google Scholar 

  15. Hernandez MC, Panchamia J, Finnesgard EJ, Leiting JL, Franssen B, Saleem H, Kendrick ML, Nagorney DM, Truty MJ, Smoot RL (2018) Transversus abdominis plane blocks with liposomal bupivacaine after open major hepatectomy is associated with reduced early patient-reported pain scores and opioid administration. Surgery. 164:1251–1258

    Article  Google Scholar 

  16. Bingener J, Sloan JA, Novotny PJ, Pockaj BA, Nelson H (2014) Perioperative patient-reported outcomes predict serious postoperative complications: a secondary analysis of the COST trial. J Gastrointest Surg 19(1):65–71

    Article  Google Scholar 

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Acknowledgements

This work was funded by a SAGES Education and Research Foundation Research Grant.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Cornelius A. Thiels, Kellie L. Mathis, Mark J. Truty & Juliane Bingener

  2. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Cornelius A. Thiels & Kristine T. Hanson

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Paul J. Novotny & Jeff A. Sloan

Authors
  1. Cornelius A. Thiels
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  2. Kristine T. Hanson
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  3. Kellie L. Mathis
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  4. Paul J. Novotny
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  5. Mark J. Truty
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  6. Jeff A. Sloan
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  7. Juliane Bingener
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Contributions

CAT, JAS, and JB contributed to the study design. CAT, KTH, KLM, PJN, MJT, JAS, and JB contributed to the analysis and interpretation. All authors contributed to the drafting and critical revisions of the manuscript and gave final approval prior to publication.

Corresponding author

Correspondence to Cornelius A. Thiels.

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Disclosures

Dr. Bingener is on the Surgeon Advisory Board of Titan Medical Inc. Support was provided by the SAGES Research Foundation. Drs. Thiels, Hanson, Mathis, Novotny, Truty, and Sloan have no conflicts of interest or financial ties to disclose.

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Thiels, C.A., Hanson, K.T., Mathis, K.L. et al. Prospective longitudinal cohort study of patient recovery after major gastrointestinal surgery: is there a difference between minimally invasive and open approaches?. Surg Endosc 34, 3126–3134 (2020). https://doi.org/10.1007/s00464-019-07073-6

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  • DOI: https://doi.org/10.1007/s00464-019-07073-6

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