Impact of in-hospital postoperative complications on quality of life up to 12 months after major abdominal surgery

Abstract

Background: Postoperative complications are common, but there are limited data regarding their implications on patients' quality of life. This study aimed to address this gap in the literature by analysing the impact of postoperative complications on patients' health-related quality of life.

Methods: Data from the Perioperative Quality Improvement Programme were analysed, and included patient-level data for 19 685 adults who underwent elective major abdominal procedures in England since 2016. Postoperative complications were graded using the Clavien-Dindo classification. Quality of life was assessed by responses to the EuroQol five-dimension five-levels-of-response (EQ-5D-5L™) questionnaire before surgery, and at 6 and 12 months after operation. Ordinal logistic regression was used to estimate the association between Clavien-Dindo grades and quality of life. Tobit and ordinary least squares regression analyses were used to estimate the quality-adjusted life-year (QALY) loss resulting from postoperative complications between admission and 12 months after surgery.

Results: At 6 and 12 months after surgery, increasingly severe postoperative complications were significantly associated with poorer health-related quality of life. The effect of postoperative complications on quality of life was sustained until at least 12 months after operation. Between admission and 12 months after surgery, 0.012, 0.026, 0.033, and 0.086 QALYs were lost for those experiencing a grade I, II, III, or IV postoperative complication respectively.

Conclusion: Postoperative complications have a significant and sustained effect on patients' quality of life after surgery; this effect worsens as the severity of the complications increases.

Fig. 1

Quality-of-life trajectory for each Clavien–Dindo grade using mean EQ-5D-5L™ values Error bars represent 95% confidence intervals.

Fig. 2

Quality-of-life trajectory for each Clavien–Dindo grade using mean EQ-5D-5L™ values adjusted for mortality Error bars represent 95% confidence intervals.

Fig. 3

Quality-of-life trajectory for each Clavien–Dindo grade using mean EQ-5D-3L™ values adjusted for mortality and missing data Error bars represent 95% confidence intervals. Multiple imputation was used in analysis of 6- and 12-month data.