Predictors of postoperative decline in quality of life after major lung resections

Abstract

Objective: Severe impairment in quality of life (QoL) is one of the major patients' fears about lung surgery. Its prediction can be valuable information for both patients and physicians. The objective of this study was to identify predictors of clinically relevant decline of the physical and emotional components of QoL after lung resection.

Methods: This is a prospective observational study on 172 consecutive patients submitted to lobectomy or pneumonectomy (2007-2008). QoL was assessed before and 3 months after operation through the administration of the Short Form 36v2 survey. The relevance of the perioperative changes in physical component summary (PCS) and mental component summary (MCS) scales was measured by the Cohen's effect size (mean change of the variable divided by its baseline standard deviation). An effect size >0.8 is regarded as large and clinically relevant. QoL changes were dichotomized according to this threshold. Logistic regression and bootstrap analyses were used to identify reliable predictors of large decline in PCS and MCS.

Results: A total of 48 patients (28%) had a large decline in the PCS scale and 26 (15%) in the MCS scale. Patients with a better preoperative physical functioning (p=0.0008) and bodily pain (p=0.048) scores and those with worse mental health (p=0.0007) scores were those at higher risk of a relevant physical deterioration. Patients with a lower predicted postoperative forced expiratory volume in 1s (ppoFEV1; p=0.04), higher preoperative scores of social functioning (p=0.02) and mental health (p=0.06) were those at higher risk of a relevant emotional deterioration. The following logistic equations were derived to calculate the risk of decline in physical or emotional components of QoL, respectively: risk of physical decline: lnR/(1+R): -11.6+0.19XPF, physical functioning+0.05XBP, bodily pain-0.05XMH, mental health; risk of emotional decline: ln R₁/(1+R₁): -8.06-0.03XppoFEV1+0.11XSF+0.055XMH.

Conclusions: A consistent proportion of patients undergoing lung resection exhibit an important postoperative worsening in their QoL. We were able to identify reliable risk factors and predictive equations estimating this decline. These findings may be used as selection criteria for efficacy trials on perioperative physical rehabilitation or psychological treatments, during preoperative counseling, in the surgical decision-making process and for selecting those patients who would benefit from physical and emotional supportive programs.