1
|
Holeman TA, Chester C, Hales JB, Zhang Y, Johnson CE, Brooke BS. Long-term patient-reported outcomes among patients undergoing revascularization vs medical therapy for intermittent claudication. J Vasc Surg 2024; 80:466-477.e4. [PMID: 38608965 PMCID: PMC11260535 DOI: 10.1016/j.jvs.2024.03.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Society for Vascular Surgery guidelines recommend revascularization for patients with intermittent claudication (IC) if it can improve patient function and quality of life. However, it is still unclear if patients with IC achieve a significant functional benefit from surgery compared with medical management alone. This study examines the relationship between IC treatment modality (operative vs nonoperative optimal medical management) and patient-reported outcomes for physical function (PROMIS-PF) and satisfaction in social roles and activities (PROMIS-SA). METHODS We identified patients with IC who presented for index evaluation in a vascular surgery clinic at an academic medical center between 2016 and 2021. Patients were stratified based on whether they underwent a revascularization procedure during follow-up vs continued nonoperative management with medication and recommended exercise therapy. We used linear mixed-effect models to assess the relationship between treatment modality and PROMIS-PF, PROMIS-SA, and ankle-brachial index (ABI) over time, clustering among repeat patient observations. Models were adjusted for age, sex, diabetes, Charlson Comorbidity Index, Clinical Frailty Score, tobacco use, and index ABI. RESULTS A total of 225 patients with IC were identified, of which 40% (n = 89) underwent revascularization procedures (42% bypass; 58% peripheral vascular intervention) and 60% (n = 136) continued nonoperative management. Patients were followed up to 6.9 years, with an average follow-up of 5.2 ± 1.6 years. Patients who underwent revascularization were more likely to be clinically frail (P = .03), have a lower index ABI (0.55 ± 0.24 vs 0.72 ± 0.28; P < .001), and lower baseline PROMIS-PF score (36.72 ± 8.2 vs 40.40 ± 6.73; P = .01). There were no differences in patient demographics or medications between treatment groups. Examining patient-reported outcome trends over time; there were no significant differences in PROMIS-PF between groups, trends over time, or group differences over time after adjusting for covariates (P = .07, P = .13, and P =.08, respectively). However, all patients with IC significantly increased their PROMIS-SA over time (adjusted P = .019), with patients managed nonoperatively more likely to have an improvement in PROMIS-SA over time than those who underwent revascularization (adjusted P = .045). CONCLUSIONS Patient-reported outcomes associated with functional status and satisfaction in activities are similar for patients with IC for up to 7 years, irrespective of whether they undergo treatment with revascularization or continue nonoperative management. These findings support conservative long-term management for patients with IC.
Collapse
Affiliation(s)
- Teryn A Holeman
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT; Department of Population Health Science, University of Utah, School of Medicine, Salt Lake City, UT.
| | - Cassidy Chester
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Julie B Hales
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Yue Zhang
- Department of Population Health Science, University of Utah, School of Medicine, Salt Lake City, UT
| | - Cali E Johnson
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, University of Utah, School of Medicine, Salt Lake City, UT; Department of Population Health Science, University of Utah, School of Medicine, Salt Lake City, UT
| |
Collapse
|
2
|
Sahba M, Krog AH, Pettersen EM, Wisløff T, Sundhagen JO, Kazmi SSH. Quality of Life (QoL) Assessment in the Patients Operated with Either Laparoscopic or an Open Aortobifemoral Bypass for Aortoiliac Occlusive Disease (AIOD): 2 Years Results of a Randomized Controlled Trial. Vasc Health Risk Manag 2022; 18:61-71. [PMID: 35221689 PMCID: PMC8865903 DOI: 10.2147/vhrm.s350836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mehdi Sahba
- Department of Vascular Surgery, Østfold Central Hospital, Kalnes, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Helene Krog
- Department of Vascular Surgery, Østfold Central Hospital, Kalnes, Norway
| | | | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Jon Otto Sundhagen
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Syed Sajid Hussain Kazmi
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
- Correspondence: Syed Sajid Hussain Kazmi, Tel +47 92468309, Email
| |
Collapse
|
3
|
Hicks CW, Vavra AK, Goldsborough E, Rebuffatti M, Almeida J, Duwayri YM, Haurani M, Ross CB, Shah SK, Shireman PK, Smolock CJ, Yi J, Woo K. Current status of patient-reported outcome measures in vascular surgery. J Vasc Surg 2021; 74:1693-1706.e1. [PMID: 34688398 PMCID: PMC9834908 DOI: 10.1016/j.jvs.2021.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023]
Abstract
A previously published review focused on generic and disease-specific patient-reported outcome measures (PROMs) relevant to vascular surgery but limited to arterial conditions. The objective of this project was to identify all available PROMs relevant to diseases treated by vascular surgeons and to evaluate vascular surgeon perceptions, barriers to widespread implementation, and concerns regarding PROMs. We provide an overview of what a PROM is and how they are developed, and summarize currently available PROMs specific to vascular surgeons. We also report results from a survey of 78 Society for Vascular Surgery members serving on committees within the Policy and Advocacy Council addressing the barriers and facilitators to using PROMs in clinical practice. Finally, we report the qualitative results of two focus groups conducted to assess granular perceptions of PROMS and preparedness of vascular surgeons for widespread implementation of PROMs. These focus groups identified a lack of awareness of existing PROMs, knowledge of how PROMs are developed and validated, and clarity around how PROMs should be used by the clinician as main subthemes for barriers to PROM implementation in clinical practice.
Collapse
Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ashley K Vavra
- Division of Vascular Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | | | - Michelle Rebuffatti
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif
| | - Jose Almeida
- Miami Vein and Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, Fl
| | - Yazan M Duwayri
- Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, Ga
| | - Mounir Haurani
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charles B Ross
- Vascular Center of Excellence, Piedmont Heart and Vascular Institute, Piedmont Healthcare, Atlanta, Ga
| | - Samir K Shah
- Division of Vascular Surgery, University of Florida, Gainesville, Fl
| | - Paula K Shireman
- Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health San Antonio, Tex; Department of Surgery, South Texas Veterans Health Care System, San Antonio, Tex
| | - Christopher J Smolock
- Department of Vascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Jeniann Yi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado, Aurora, Colo
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif.
| |
Collapse
|
4
|
Roberts DJ, Nagpal SK, Forster AJ, Brandys T, Murphy C, Jennings A, Strauss SA, Vishnyakova E, Lawson J, McIsaac DI. Disability, pain, and wound-specific concerns self-reported by adults at risk of limb loss: A cross-sectional study using the World Health Organization Disability Assessment Schedule 2.0. PLoS One 2021; 16:e0253288. [PMID: 34129633 PMCID: PMC8205167 DOI: 10.1371/journal.pone.0253288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction There has been limited study of patient-reported outcomes (PROs) in patients at risk of limb loss. Our primary objective was to estimate the prevalence of disability in this patient population using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Materials and methods We recruited patients referred to a limb-preservation clinic. Patients self-reported their disability status using the 12-domain WHODAS 2.0. Severity of disability in each domain was scored from 1 = none to 5 = extreme and the total normalized to a 100-point scale (total score ≥25 = clinically significant disability). We also asked patients about wound-specific concerns and wound-related discomfort or distress. Results We included 162 patients. Reasons for clinic referral included arterial-insufficient (37.4%), postoperative (25.9%), and mixed etiology (10.8%) wounds. The mean WHODAS 2.0 disability score was 35.0 (standard deviation = 16.0). One-hundred-and-nineteen (73.5%) patients had clinically significant disability. Patients reported they had the greatest difficulty walking a long distance (mean score = 4.2), standing for long periods of time (mean score = 3.6), taking care of household responsibilities (mean score = 2.7), and dealing with the emotional impact of their health problems (mean score = 2.5). In the two-weeks prior to presentation, 87 (52.7%) patients expressed concern over their wound(s) and 90 (55.6%) suffered a moderate amount or great deal of wound-related discomfort or distress. In adjusted ordinary least squares regression models, although WHODAS 2.0 disability scores varied with changes in wound volume (p = 0.03) and total revised photographic wound assessment tool scores (p<0.001), the largest decrease in disability severity was seen in patients with less wound-specific concerns and wound-related discomfort and distress. Discussion The majority of people at risk of limb loss report suffering a substantial burden of disability, pain, and wound-specific concerns. Research is needed to further evaluate the WHODAS 2.0 in a multicenter fashion among these patients and determine whether care and interventions may improve their PROs.
Collapse
Affiliation(s)
- Derek J. Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - Sudhir K. Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan J. Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Murphy
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Jennings
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shira A. Strauss
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Evgeniya Vishnyakova
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Lawson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel I. McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
5
|
Bouwens E, van Lier F, Rouwet EV, Verhagen HJM, Stolker RJ, Hoeks SE. Type D Personality and Health-Related Quality of Life in Vascular Surgery Patients. Int J Behav Med 2019; 26:343-351. [PMID: 31264102 PMCID: PMC6652784 DOI: 10.1007/s12529-018-09762-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study evaluated the association of type D personality and health-related quality of life (HRQoL) and assessed the stability of type D personality in vascular surgery patients during the year after surgery. METHOD In a prospective cohort study between 2008 and 2014, 294 patients were assessed with validated questionnaires preoperatively and at 1, 6, and 12 months after surgery. Associations between type D personality, depression, and HRQoL were analyzed by generalized estimating equation models. Type D personality was analyzed in its standard dichotomous form as well as continuous (z) scores of its two components, negative affectivity (NA) and social inhibition (SI), and their interaction term. RESULTS Prevalence of type D personality varied between 18% and 25%. However, only 9% of the complete responders were classified as type D personality at all four assessments, whereas one third changed between type D classifications. Continuous scores showed greater stability over time. Dichotomized type D personality measured over time was significantly associated with impaired HRQoL, but this was not the case if measured once at baseline, like in general use. The continuous NA score and depression were also significantly associated with impaired HRQoL over time. CONCLUSION Type D personality was not a stable trait over time. Preoperative assessment of type D personality did not predict improvement in HRQoL after vascular surgery. However, the study revealed associations between the NA component of type D personality, depression, and lower HRQoL. This indicates that measures of overall negative affect should be taken into account when assessing HRQoL patient-reported outcomes in vascular surgery patients.
Collapse
Affiliation(s)
- Elke Bouwens
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Erasmus MC, NA-1718, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Felix van Lier
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Erasmus MC, NA-1718, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Ellen V Rouwet
- Department of Vascular Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Erasmus MC, NA-1718, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Sanne E Hoeks
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Erasmus MC, NA-1718, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands.
| |
Collapse
|
6
|
Doyen B, Bicknell CD, Riga CV, Van Herzeele I. Evidence Based Training Strategies to Improve Clinical Practice in Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2018; 56:751-758. [PMID: 30206016 DOI: 10.1016/j.ejvs.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Colin D Bicknell
- Department of Vascular Surgery, Imperial College London, London, UK
| | - Celia V Riga
- Department of Vascular Surgery, Imperial College London, London, UK
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| |
Collapse
|
7
|
Patient-Reported Outcome Measures in Carotid Artery Revascularization: Systematic Review and Psychometric Analysis. Ann Vasc Surg 2018; 50:275-283. [DOI: 10.1016/j.avsg.2017.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/23/2022]
|
8
|
Kazmi SS, Krog AH, Berge ST, Sundhagen JO, Sahba M, Falk RS. Patient-perceived health-related quality of life before and after laparoscopic aortobifemoral bypass. Vasc Health Risk Manag 2017; 13:169-176. [PMID: 28546754 PMCID: PMC5437970 DOI: 10.2147/vhrm.s134669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background In patients operated with laparoscopic aortobifemoral bypass (LABFB) for atherosclerotic obstruction in aortoiliac segment, the main focus of the reports published during the last two decades has been morbidity and mortality. The primary objective of this study was to examine the health-related quality of life (HRQL) in these patients before and after LABFB. Patients and methods Fifty consecutive patients (27 females) with Trans-Atlantic Inter-Society Consensus II, type D lesions were prospectively included. Short-Form 36 (SF-36) questionnaire was used to get information about the HRQL before LABFB and at 1, 3 and 6 months after the operation. Main indication for LABFB was intermittent claudication. Linear mixed-effect models were used to assess changes in HRQL over time. Age, gender, smoking, blood loss, operation time, concomitant operation, the American Society of Anesthesiologists category, length of hospital stay, previous vascular procedures and aorta cross-clamping were used as fixed factors and their impact on the physical components of the SF-36, as well as the summary scores were determined with univariate analysis. Variables with P<0.2 were included in the multivariate regression analysis. P<0.05 was considered statistically significant. Results Statistically significant improvement was found in all SF-36 domains as well as in the summary scores after LABFB compared to the preoperative scores. The improvement in scores was substantial already at 1 month and the effect was maintained at 3 and 6 months survey time points. Concomitant operations had a statistically significant negative impact on the physical components of SF-36. Data completeness of item questionnaires was 93% in the whole material. Reliability scale and homogeneity estimates for the eight domains had high internal consistency. Conclusion Patients operated with LABFB for Trans-Atlantic Inter-Society Consensus II, type D lesions have reduced HRQL. LABFB leads to substantial and statistically significant improvement in the patients’ HRQL, when examined with SF-36. These results need to be replicated by a randomized clinical trial.
Collapse
Affiliation(s)
- Syed Sh Kazmi
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital
| | - Anne H Krog
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital.,Institute of Clinical Medicine, University of Oslo, Oslo
| | - Simen T Berge
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital
| | - Jon O Sundhagen
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital
| | - Mehdi Sahba
- Department of Vascular Surgery, Østfold Central Hospital, Kalnes
| | - Ragnhild S Falk
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo University Hospital, Oslo, Norway
| |
Collapse
|