Preoperative quality of life predicts complications in thoracic surgery: a retrospective cohort study

Eagan J Peters; Gordon Buduhan; Lawrence Tan; Sadeesh K Srinathan; Biniam Kidane

doi:10.1093/ejcts/ezae301

Preoperative quality of life predicts complications in thoracic surgery: a retrospective cohort study

Eur J Cardiothorac Surg. 2024 Aug 2;66(2):ezae301. doi: 10.1093/ejcts/ezae301.

Authors

Eagan J Peters^{1

2}, Gordon Buduhan^{2

3}, Lawrence Tan², Sadeesh K Srinathan², Biniam Kidane^{2

4

5

6}

Affiliations

¹ Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
³ Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴ CancerCare Manitoba Research Institute, University of Manitoba, Winnipeg, MB, Canada.
⁵ Department of Physiology & Pathophysiology, University of Manitoba, Winnipeg, MB, Canada.
⁶ Department of Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada.

PMID: 39133147
DOI: 10.1093/ejcts/ezae301

Abstract

Objectives: Patients undergoing thoracic surgery experience high complication rates. It is uncertain whether preoperative health-related quality of life (HRQOL) measurements can predict patients at higher risk for postoperative complications. The objective of this study was to determine the association between preoperative HRQOL and postoperative complications among patients undergoing thoracic surgery.

Methods: This was a retrospective cohort study of prospectively collected data. Consecutive patients undergoing elective thoracic surgery at a Canadian tertiary care centre between January 2018 and January 2019 were included. Patient HRQOL was measured using the Euroqol-5 Dimension (EQ-5D) survey. Complications were recorded using the Ottawa Thoracic Morbidity and Mortality system. Uni- and multivariable analysis were performed.

Results: Of 515 surgeries performed, 133 (25.8%) patients experienced at least 1 postoperative complication; 345 (67.0%) patients underwent surgery for malignancy. A range of 271 (52.7%) to 310 (60.2%) patients experienced pain/discomfort at each timepoint. On multivariable analysis, lower preoperative EQ-5D visual analogue scale scores were significantly associated with postoperative complications (adjusted odds ratio 0.97, 95% confidence interval 0.95-0.99; P = 0.01). Presence of malignancy was not independently associated with complications (P = 0.68).

Conclusions: Self-reported preoperative HRQOL can predict incidence of postoperative complications among patients undergoing thoracic surgery. Assessments of preoperative HRQOL may help identify patients at higher risk for developing complications. These findings could be used to direct preoperative risk-mitigation strategies in areas of HRQOL where patients suffer most, such as pain. The full perioperative trajectory of patient HRQOL should be discerned to identify subsets of patients who share common risk factors.

Keywords: Health-related quality of life; Lung cancer; Oesophageal cancer; Patient-reported outcomes; Postoperative complications; Thoracic surgery.

MeSH terms

Aged
Female
Humans
Male
Middle Aged
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Postoperative Complications* / psychology
Preoperative Period
Quality of Life*
Retrospective Studies
Risk Factors
Thoracic Surgical Procedures* / adverse effects

Grants and funding

University of Manitoba Department of Surgery