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Observational Study
. 2017 Aug;26(8):2093-2102.
doi: 10.1007/s11136-017-1560-2. Epub 2017 Mar 29.

Changes in quality of life after elective surgery: an observational study comparing two measures

Vanessa L Kronzer  1 , Michelle R Jerry  2 , Arbi Ben Abdallah  1 , Troy S Wildes  1 , Sherry L McKinnon  1 , Anshuman Sharma  1 , Michael S Avidan  3
Affiliations
Observational Study

Changes in quality of life after elective surgery: an observational study comparing two measures

Vanessa L Kronzer et al. Qual Life Res. 2017 Aug.

Abstract

Purpose: 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.

Methods: 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).

Results: 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.

Conclusions: Subjective global quality of life report does not agree well with a validated quality of life instrument, perhaps due to patient over-optimism.

Keywords: Elective surgical procedures; Minimum clinically important difference (MCID); Outcome assessment; Patient-reported outcomes; Quality of life.

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Conflict of interest statement

Conflicts of interest: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Proportion of patients experiencing change in physical quality of life, by global assessment response
Fig. 2
Fig. 2
Change in global (a) and VR-12 (b) quality of life, by surgical specialty
See this image and copyright information in PMC

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