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Clausen J, Boesen V, Gögenur I, Watt T. A Content Framework of a Novel Patient-Reported Outcome Measure for Detecting Early Adverse Events After Major Abdominal Surgery. World J Surg 2023; 47:2676-2687. [PMID: 37610468 PMCID: PMC10545596 DOI: 10.1007/s00268-023-07143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Systematic health monitoring with patient-reported outcome instruments may predict post-discharge complications after major surgery. The objective of this study was to conceptualize a novel patient-reported outcome instrument for detecting early adverse events within two weeks of discharge after major emergency abdominal surgery and colorectal cancer surgery. METHODS This study was conducted in two phases. (1) An exhaustive health concept pool was generated using systematic content analysis of existing patient-reported outcome measures (N = 31) and semi-structured interviews of readmitted patients (N = 49) and health professionals (N = 10). Concepts were categorized into three major domains: 'Symptoms,' 'functional status,' and 'general health perception.' We calculated the frequency of each health concept as the proportion of patients, who experienced the respective concept prior to readmission. (2) Colorectal cancer surgeons (N = 13) and emergency general surgeons (N = 12) rated the relevance of each health concept (1 = irrelevant, 5 = very relevant) in the context of detecting post-discharge adverse events. We selected concepts with either a high mean relevance score (≥ 4) or a combination of moderate mean relevance score and high patient-reported frequency (≥ 3 and ≥ 20% or ≥ 2.5 and ≥ 50%, respectively). RESULTS Content analysis of existing items with additions from patients and experts resulted in 58 health concepts, of which the majority were distinct symptoms (N = 40). The selection procedure resulted in 29 patient-reported health concepts relevant for detecting adverse events after discharge. CONCLUSION The outlined framework provides content validity for future patient-reported outcome instruments detecting adverse events in the early post-discharge period after major emergency abdominal surgery and colorectal cancer surgery.
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Affiliation(s)
- Johan Clausen
- Center for Surgical Science, Surgical Department, Zealand's University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark.
| | - Victor Boesen
- Department of Endocrinology, Gentofte and Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Surgical Department, Zealand's University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | - Torquil Watt
- Department of Endocrinology, Gentofte and Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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Patient-reported outcome measures to evaluate postoperative quality of life in patients undergoing elective abdominal surgery: a systematic review. Qual Life Res 2022; 31:2267-2279. [DOI: 10.1007/s11136-021-03071-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
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Cheng LJ, Tan RLY, Luo N. Measurement Properties of the EQ VAS Around the Globe: A Systematic Review and Meta-Regression Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1223-1233. [PMID: 34372988 DOI: 10.1016/j.jval.2021.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 05/26/2023]
Abstract
OBJECTIVES This study aimed to synthesize and evaluate published evidence on the measurement properties of the EQ VAS, a component of all EQ-5D questionnaires. METHODS This systematic review followed the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Five electronic databases were searched for EQ-5D-3L and EQ-5D-5L validation articles published from January 1, 2009, to November 5, 2019. Evidence for construct validity, test-retest reliability, and responsiveness was extracted from individual studies before being aggregated for evaluation of the populations represented by the studied samples. Multivariable logistic meta-regression was conducted to explore the effects of potential covariates on construct validity. RESULTS A total of 50 articles containing 488 studies, using samples drawn from 12 different populations, were identified. Generally, the quality of evidence was high for construct validity studies (n = 397) but only moderate for both test-retest reliability studies (n = 21) and responsiveness studies (n = 70). "Sufficient" construct validity of EQ VAS was found in 8 of 12 populations, "sufficient" test-retest reliability was found in 3 of 11 populations, and "sufficient" responsiveness was found in 5 of 12 populations. Meta-regression analyses suggested that construct validity studies from the Asian-Pacific region were more likely to show a negative rating compared with studies from Europe and North America. CONCLUSION The EQ VAS exhibits "sufficient" construct validity, "inconsistent" test-retest reliability, and "inconsistent" responsiveness across a broad range of populations. Additional studies are needed to explore the suboptimal validity of the EQ VAS in the Asian-Pacific region, whereas more high-quality validation studies are needed to assess its reliability and responsiveness.
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Affiliation(s)
- Ling Jie Cheng
- Nursing Research Unit, Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore; Health Systems & Behavioral Sciences, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Rachel Lee-Yin Tan
- Health Systems & Behavioral Sciences, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Nan Luo
- Health Systems & Behavioral Sciences, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Huang HY, Wang H, Shi JF, Bai YN, Wang L, Liu CC, Yan XX, Liu GX, Liao XZ, Shi D, Mao AY, Ren JS, Sun XJ, Guan HJ, Huang WD, Lei HK, Gong JY, Liu YY, Zhu L, Song BB, Du LB, Guo LW, Liu YQ, Ren Y, Lan L, Zhou JY, Qi X, Sun XH, Lou PA, Wu SL, Tang Y, Li N, Zhang K, Li N, Chen WQ, Dai M, He J. Health-related quality of life of patients with colorectal neoplasms in China: A multicenter cross-sectional survey. J Gastroenterol Hepatol 2021; 36:1197-1207. [PMID: 32875595 DOI: 10.1111/jgh.15238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM This study aimed to clarify health-related quality of life (HRQoL) of patients with colorectal precancer and colorectal cancer (CRC) in China and to better understand related utility scores. METHODS A hospital-based cross-sectional survey was conducted in precancer and CRC patients from 2012 to 2014, covering 12 provinces in China. HRQoL was assessed with EuroQol 5-Dimensions 3-Levels. Utility scores were derived using Chinese value set. A multivariate regression model was established to explore potential predictors of utility scores. RESULTS A total of 376 precancer (mean age 58.7 years, 61.2% men) and 2470 CRC patients (mean age 58.6 years, 57.6% men) were included. In five dimensions, there was a certain percentage of problem reported among precancer (range: 12.0% to 36.7%) and CRC (range: 32.4% to 50.3%) patients, with pain/discomfort being the most serious dimension. Utility scores of precancer and CRC patients were 0.870 (95% confidence interval [CI], 0.855-0.886) and 0.751 (95% CI, 0.742-0.759), both of which were lower than those of general Chinese population (0.960 [95% CI, 0.960-0.960]). Utilities for patients at stage I to stage IV were 0.742 (95% CI, 0.715-0.769), 0.722 (95% CI, 0.705-0.740), 0.756 (95% CI, 0.741-0.772), and 0.745 (95% CI, 0.742-0.767), respectively. Multivariate analysis showed that therapeutic regimen, time point of the interview, education, occupation, annual household income, and geographic region were associated with utilities of CRC patients. CONCLUSION Health-related quality of life of both precancer and CRC patients in China declined considerably. Utility scores differed by sociodemographic and clinical characteristics, and findings of these utilities may facilitate implementation of further cost-utility evaluations.
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Affiliation(s)
- Hui-Yao Huang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ju-Fang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Na Bai
- Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, China
| | - Le Wang
- Department of Cancer Prevention, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Cancer and Basic Medicine(ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Cheng-Cheng Liu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-Xin Yan
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guo-Xiang Liu
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Xian-Zhen Liao
- Hunan Office for Cancer Control and Research, Hunan Provincial Cancer Hospital, Changsha, China
| | - Dian Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou, China
| | - A-Yan Mao
- Public Health Information Research Office, Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian-Song Ren
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Jie Sun
- Center for Health Management and Policy, Key Lab of Health Economics and Policy, Shandong University, Jinan, China
| | - Hai-Jing Guan
- China Center for Health Economic Research, Peking University, Beijing, China
| | - Wei-Dong Huang
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Hai-Ke Lei
- Chongqing Office for Cancer Control and Research, Chongqing Cancer Hospital, Chongqing, China
| | - Ji-Yong Gong
- Science and Education Department of Public Health Division, Shandong Tumor Hospital, Jinan, China
| | - Yun-Yong Liu
- Liaoning Office for Cancer Control and Research, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Lin Zhu
- Teaching and Research Department, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China
| | - Bing-Bing Song
- Heilongjiang Office for Cancer Control and Research, Affiliated Cancer Hospital of Harbin Medical University, Harbin, China
| | - Lin-Bing Du
- Department of Cancer Prevention, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Cancer and Basic Medicine(ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Lan-Wei Guo
- Department of Institute of Tumor Research, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu-Qin Liu
- Cancer Epidemiology Research Center, Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Ying Ren
- Urban Office of Cancer Early Detection and Treatment, Tieling Central Hospital, Tieling, China
| | - Li Lan
- Institute of Chronic disease prevention and control, Harbin Center for Disease Control and Prevention, Harbin, China
| | - Jin-Yi Zhou
- Institute of Chronic Non-communicable Diseases Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiao Qi
- Department of Occupational Medicine, Tangshan People's Hospital, Tangshan, China
| | - Xiao-Hua Sun
- Ningbo Clinical Cancer Prevention Guidance Center, Ningbo No. 2 Hospital, Ningbo, China
| | - Pei-An Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Shou-Ling Wu
- Health Department of Kailuan Group, Kailuan General Hospital, Tangshan, China
| | - Yu Tang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Zhang
- Department of Physical Examination on Cancer, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wan-Qing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Dai
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF, Shaw AD, Thacker JKM, Gan TJ, Miller TE, Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway. Anesth Analg 2019; 126:1874-1882. [PMID: 29293180 DOI: 10.1213/ane.0000000000002758] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.
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Affiliation(s)
- Ramon E Abola
- From the Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York
| | | | - Michael L Kent
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Liane S Feldman
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julio F Fiore
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew D Shaw
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie K M Thacker
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Tong J Gan
- From the Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York
| | - Timothy E Miller
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Construct Validity and Responsiveness of the Abdominal Surgery Impact Scale in the Context of Recovery After Colorectal Surgery. Dis Colon Rectum 2019; 62:309-317. [PMID: 30489323 DOI: 10.1097/dcr.0000000000001288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The Abdominal Surgery Impact Scale is a patient-reported outcome measure that evaluates quality of life after abdominal surgery. Evidence supporting its measurement properties is limited. OBJECTIVE This study aimed to contribute evidence for the construct validity and responsiveness of the Abdominal Surgery Impact Scale as a measure of recovery after colorectal surgery in the context of an enhanced recovery pathway. DESIGN This is an observational validation study designed according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. SETTING This study was conducted at a university-affiliated tertiary hospital. PATIENTS Included were 100 consecutive patients undergoing colorectal surgery (mean age, 65; 57% male). INTERVENTION There were no interventions. MAIN OUTCOME MEASURES Construct validity was assessed at 2 days and 2 and 4 weeks after surgery by testing the hypotheses that Abdominal Surgery Impact Scale scores were higher 1) in patients without vs with postoperative complications, 2) with higher preoperative physical status vs lower, 3) without vs with postoperative stoma, 4) in men vs women, 5) with shorter time to readiness for discharge (≤4 days) vs longer, and 6) with shorter length of stay (≤4 days) vs longer. To test responsiveness, we hypothesized that scores would be higher 1) preoperatively vs 2 days postoperatively, 2) at 2 weeks vs 2 days postoperatively, and 3) at 4 weeks vs 2 weeks postoperatively. RESULTS The data supported 3 of the 6 hypotheses (hypotheses 1, 5, and 6) tested for construct validity at all time points. Two of the 3 hypotheses tested for responsiveness (hypotheses 1 and 2) were supported. LIMITATIONS This study was limited by the risk of selection bias due to the use of secondary data from a randomized controlled trial. CONCLUSIONS The Abdominal Surgery Impact Scale was responsive to the expected trajectory of recovery up to 2 weeks after surgery, but did not discriminate between all groups expected to have different recovery trajectories. There remains a need for the development of recovery-specific, patient-reported outcome measures with adequate measurement properties. See Video Abstract at http://links.lww.com/DCR/A814.
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Ferraz SM, Moreira JP, Mendes LC, Amaral TM, Andrade AR, Santos AR, Abelha FJ. Evaluation of the quality of recovery and the postoperative health status after elective surgery. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30197270 PMCID: PMC9391732 DOI: 10.1016/j.bjane.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose Postoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery. Methods This observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale. Results Before surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months. Conclusions Patients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.
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Abstract
Enhanced recovery programs were developed as a means for improving patient recovery after surgery with a multifaceted approach including several interventions in the perioperative period. There is now sufficient evidence in the literature that enhanced recovery programs have actually shortened hospital length of stay after colorectal surgery. Nonetheless, the impact of these successful programs on patient-reported outcomes like functional recovery and return to baseline quality of life is not known.
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Ferraz SM, Moreira JP, Mendes LC, Amaral TM, Andrade AR, Santos AR, Abelha FJ. [Evaluation of the quality of recovery and the postoperative health status after elective surgery]. Rev Bras Anestesiol 2018; 68:577-583. [PMID: 30197270 DOI: 10.1016/j.bjan.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/10/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Postoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery. METHODS This observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale. RESULTS Before surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months. CONCLUSIONS Patients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.
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Affiliation(s)
- Sofia M Ferraz
- Centro Hospitalar de São João, Departamento de Anestesiologia, Porto, Portugal
| | - João P Moreira
- Centro Hospitalar de São João, Departamento de Anestesiologia, Porto, Portugal
| | - Leonor C Mendes
- Centro Hospitalar de São João, Departamento de Anestesiologia, Porto, Portugal
| | - Tania M Amaral
- Centro Hospitalar de São João, Departamento de Anestesiologia, Porto, Portugal
| | - Ana R Andrade
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Alice R Santos
- Centro Hospitalar de São João, Departamento de Anestesiologia, Porto, Portugal
| | - Fernando J Abelha
- Centro Hospitalar de São João, Departamento de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Departamento de Cirurgia e Fisiologia, Porto, Portugal.
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Alam R, Figueiredo SM, Balvardi S, Nauche B, Landry T, Lee L, Mayo NE, Feldman LS, Fiore JF. Development of a patient-reported outcome measure of recovery after abdominal surgery: a hypothesized conceptual framework. Surg Endosc 2018; 32:4874-4885. [DOI: 10.1007/s00464-018-6242-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/09/2018] [Indexed: 01/31/2023]
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Dahlberg K, Philipsson A, Hagberg L, Jaensson M, Hälleberg-Nyman M, Nilsson U. Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial. Br J Anaesth 2017; 119:1039-1046. [DOI: 10.1093/bja/aex332] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/15/2022] Open
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Cost-effectiveness of Enhanced Recovery Versus Conventional Perioperative Management for Colorectal Surgery. Ann Surg 2016; 262:1026-33. [PMID: 25371130 DOI: 10.1097/sla.0000000000001019] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of enhanced recovery pathways (ERPs) versus conventional care for patients undergoing elective colorectal surgery. BACKGROUND ERPs for colorectal surgery are clinically effective, but their cost-effectiveness is unknown. METHODS A multi-institutional prospective cohort cost-effectiveness analysis was performed. Adult patients undergoing elective colorectal resection at 2 university-affiliated institutions from October 2012 to October 2013 were enrolled. One center used an ERP, whereas the other did not. Postoperative outcomes were recorded up to 60 days. Total costs were reported in 2013 Canadian dollars. Effectiveness was measured using the SF-6D, a health utility measure validated for postoperative recovery. Uncertainty was expressed using bootstrapped estimates (10,000 repetitions). RESULTS A total of 180 patients were included (conventional care: n = 95; ERP: n = 95). There were no differences in patient characteristics except for a higher proportion of laparoscopy in the ERP group. Mean length of stay was shorter in the ERP group (6.5 vs 9.8 days; P = 0.017), but there were no differences in complications or readmissions. Patients in the ERP group returned to work quicker and had less caregiver burden. There was no difference in quality of life between the 2 groups. The cost of the ERP program was $153 per patient. Overall societal costs were lower in the ERP group (mean difference = -2985; 95% confidence interval, -5753 to -373). The ERP had a greater than 99% probability of cost-effectiveness. The results were insensitive to a range of assumptions and subgroups. CONCLUSIONS Enhanced recovery is cost-effective compared with conventional perioperative management for elective colorectal resection.
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Standardizing endpoints in perioperative research. Can J Anaesth 2016; 63:159-68. [DOI: 10.1007/s12630-015-0565-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022] Open
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Payakachat N, Ali MM, Tilford JM. Can The EQ-5D Detect Meaningful Change? A Systematic Review. PHARMACOECONOMICS 2015; 33:1137-54. [PMID: 26040242 PMCID: PMC4609224 DOI: 10.1007/s40273-015-0295-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The EQ-5D is one of the most frequently used, generic, preference-based instruments for measuring the health utilities of patients in economic evaluations. It is recommended for health technology assessment by the National Institute for Health and Clinical Excellence. Because the EQ-5D plays such an important role in economic evaluations, useful information on its responsiveness to detect meaningful change in health status is required. OBJECTIVE This study systematically reviewed and synthesized evidence on the responsiveness of the EQ-5D to detect meaningful change in health status for clinical research and economic evaluations. METHODS We searched the EuroQol website, PubMed, PsychINFO, and EconLit databases to identify studies published in English from the inception of the EQ-5D until August 15, 2014 using keywords that were related to responsiveness. Studies that used only the EQ-VAS were excluded from the final analysis. Narrative synthesis was conducted to summarize evidence on the responsiveness of the EQ-5D by conditions or physiological functions. RESULTS Of 1401 studies, 145 were included in the narrative synthesis and categorized into 19 categories for 56 conditions. The EQ-5D was found to be responsive in 25 conditions (45 %) with the magnitude of responsiveness varying from small to large depending on the condition. There was mixed evidence of responsiveness in 27 conditions (48 %). Only four conditions (7 %) (i.e., alcohol dependency, schizophrenia, limb reconstruction, and hearing impairment) were identified where the EQ-5D was not responsive. CONCLUSION The EQ-5D is an appropriate measure for economic evaluation and health technology assessment in conditions where it has demonstrated evidence of responsiveness. In conditions with mixed evidence of responsiveness, researchers should consider using the EQ-5D with other condition-specific measures to ensure appropriate estimates of effectiveness. These conditions should be a main focus for future research using the new EQ-5D version with five response levels.
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Affiliation(s)
- Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #522, Little Rock, AR, 72205, USA.
| | - Mir M Ali
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Mick Tilford
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #522, Little Rock, AR, 72205, USA
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Lee L, Dumitra T, Fiore JF, Mayo NE, Feldman LS. How well are we measuring postoperative “recovery” after abdominal surgery? Qual Life Res 2015; 24:2583-90. [DOI: 10.1007/s11136-015-1008-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 01/22/2023]
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Feldman LS, Lee L, Fiore J. What outcomes are important in the assessment of Enhanced Recovery After Surgery (ERAS) pathways? Can J Anaesth 2014; 62:120-30. [PMID: 25391733 DOI: 10.1007/s12630-014-0263-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/24/2014] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The purpose of this narrative review is to provide a framework from which to measure the outcomes of Enhanced Recovery After Surgery (ERAS) programs. PRINCIPLE FINDINGS We define the outcomes of recovery from the perspective of different stakeholders and time frames. There is no single definition of recovery. There are overlapping phases of recovery which are of particular interest to different stakeholders (surgeons, anesthesiologists, nurses, patients and their caregivers), and the primary outcome of interest may vary depending on the phase and the perspective. In the earliest phase (from the end of the surgery to discharge from the postanesthesia care unit [PACU]), biologic and physiologic outcomes are emphasized. In the intermediate phase (from PACU to discharge from the hospital), symptoms related to pain and gastrointestinal function as well as basic activities are important. Studies of ERAS pathways have reported clinical outcomes and symptoms, including complications, hospital stay, mobilization, and gastrointestinal function, largely during hospitalization. Nevertheless, patients define recovery as return to normal functioning, a process that occurs over weeks to months (late phase). Outcomes reflecting functional status (e.g., physical activity, activities of daily living) and overall health (e.g., quality of life) are important in this phase. To date, few studies reporting the effectiveness of ERAS pathways compared with conventional care have included functional status or quality-of-life outcomes, and there is little information about recovery after discharge from hospital. CONCLUSION Recovery after surgery is a complex construct. Different outcomes are important at different phases along the recovery trajectory. Measures for quantifying recovery in hospital and after discharge are available. A consensus-based core set of outcomes with input from multiple stakeholders would facilitate research reporting.
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Affiliation(s)
- Liane S Feldman
- Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9-303, Montreal, QC, H3G 1A4, Canada,
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