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Comparative Study
. 2015 Sep;150(3):613-9.e2.
doi: 10.1016/j.jtcvs.2015.05.057. Epub 2015 May 28.

Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory

Christopher P Fagundes  1 , Qiuling Shi  2 , Ara A Vaporciyan  3 , David C Rice  3 , Keyuri U Popat  4 , Charles S Cleeland  2 , Xin Shelley Wang  5
Affiliations
Comparative Study

Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory

Christopher P Fagundes et al. J Thorac Cardiovasc Surg. 2015 Sep.

Abstract

Objectives: Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay), to evaluate perioperative care. This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer.

Methods: Newly diagnosed patients (N = 60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory. We conducted Kaplan-Meier analyses to determine when symptoms returned to presurgical levels and to mild-severity levels during recovery.

Results: The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer. Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05).

Conclusions: Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions.

Keywords: MDASI; VATS; enhanced recovery; patient-reported outcome (PRO); postoperative care; symptoms.

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Figures

FIGURE 1
FIGURE 1
Severity levels over time for the 5 most-severe symptoms after thoracic surgery.
FIGURE 2
FIGURE 2
Time to symptom recovery to mild severity after thoracic surgery. A, Kaplan–Meier curves for the 5 most-severe symptoms overall. B, Kaplan–Meier curves for difference in pain recovery between standard open thoracotomy and VATS lobectomy (P = .022). “Return to mild pain” was defined as a report of MDASI pain scores ≤3 (none or mild) at 2 contiguous measurements. VATS, video-assisted thoracoscopic surgery. See Supplemental Tables S2 and S3 for additional data related to Figures 2A and 2B, respectively, on the number of patients with moderate to severe symptoms and the probability of recovery at given time points during the study.
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