Changes in quality of life after elective surgery: an observational study comparing two measures
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Our main objective was to compare the change in a validated quality of life measure to a global assessment measure. The secondary objectives were to estimate the minimum clinically important difference (MCID) and to describe the change in quality of life by surgical specialty.
This prospective cohort study included 7902 adult patients undergoing elective surgery. Changes in the Veterans RAND 12-Item Health Survey (VR-12), composed of a physical component summary (PCS) and a mental component summary (MCS), were calculated using preoperative and postoperative questionnaires. The latter also contained a global assessment question for quality of life. We compared PCS and MCS to the global assessment using descriptive statistics and weighted kappa. MCID was calculated using an anchor-based approach. Analyses were pre-specified and registered (NCT02771964).
By the change in VR-12 scores, an equal proportion of patients experienced improvement and deterioration in quality of life (28% for PCS, 25% for MCS). In contrast, by the global assessment measure, 61% reported improvement, while only 10% reported deterioration. Agreement with the global assessment was slight for both PCS (kappa = 0.20, 57% matched) and MCS (kappa = 0.10, 54% matched). The MCID for the overall VR-12 score was approximately 2.5 points. Patients undergoing orthopedic surgery showed the most improvement in quality of life measures, while patients undergoing gastrointestinal/hepatobiliary or urologic surgery showed the most deterioration.
Subjective global quality of life report does not agree well with a validated quality of life instrument, perhaps due to patient over-optimism.
KeywordsQuality of life Outcome assessment Patient-reported outcomes Minimum clinically important difference (MCID) Elective surgical procedures
We thank Dawn Anderson, Marsha Fizette, Mark Foesterling, Stacey Hellman, Michelle Hieger, Mary Kehrer, Jill Lafata,Jessica McGowan, Angelika Nagele, Keryn Padgett, Mary Scherer, Tina Thomlison, Bonnie Vemmer, Linda Wiemer, Pathena Williams, Tammy Murphy, and Amy Campbell for their hard work in consenting patients for SATISFY-SOS.
VLK was supported by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) [Grant UL1TR000448, subaward TL1TR000449]. MSA was supported by the National Institute on Aging [Grant 1UH2AG050312-01] and the Barnes Jewish Hospital Foundation [Grant BJHF#7937-77]. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. The funding sources provided infrastructure and financial support but had no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study.
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