术后并发症对胰腺切除术后健康相关生活质量和功能恢复的影响:一项前瞻性观察研究的结果。

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-11-01 Epub Date: 2024-08-05 DOI:10.1097/SLA.0000000000006472
Nicolò Pecorelli, Giovanni Guarneri, Francesca Di Salvo, Alessia Vallorani, Chiara Limongi, Gianluca Corsi, Giulia Gasparini, Martina Abati, Stefano Partelli, Stefano Crippa, Massimo Falconi
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引用次数: 0

摘要

目的评估术后并发症对胰腺手术后患者健康相关生活质量(HRQoL)和存活率的影响程度:胰腺切除术常伴有严重的术后发病率,这会影响患者的康复。关于胰腺切除术后并发症对患者报告的 HRQoL 的影响,现有数据很少且相互矛盾:这是一项观察性队列研究,包括连续加入前瞻性临床试验(NCT04431076)、接受择期胰腺切除术(2020-2022 年)的患者。在手术前和术后第 15、30、90、180 天 (POD),患者填写 PROMIS-29 资料和杜克活动状态指数问卷,以评估其 HRQoL 和功能能力。采用多变量线性回归法得出 HRQoL 评分的平均差异,并对术前评分和混杂因素进行调整:528名患者中,370人(70%)在90天内发病,154人(29%)出现严重并发症(克拉维恩-丁多分级>2)。与无并发症患者相比,胃排空延迟对患者的 HRQoL 影响最大,POD90 和 POD180 患者的心理健康和身体健康均有所下降。在大多数领域,并发症严重程度等级与 HRQoL 之间存在明显的反比关系,克拉维恩-丁度 3b-4 级患者在术后 6 个月内的 HRQoL 和功能能力评分较差。在235名胰腺癌患者中,3b级和4级并发症与疾病特异性生存期的降低有关(中位生存期分别为25个月和41个月):在接受胰腺切除术的患者中,术后并发症对患者生活质量的各个领域都有显著影响,并发症的严重程度与患者生活质量和功能能力的损害之间存在剂量效应关系。
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The Impact of Postoperative Complications on Recovery of Health-Related Quality of Life and Functional Capacity After Pancreatectomy: Findings From a Prospective Observational Study.

Objective: To evaluate the extent to which postoperative complications impact patient health-related quality of life (HRQoL) and survival after pancreatic surgery.

Background: Pancreatectomy is frequently associated with severe postoperative morbidity, which can affect patient recovery. Few and conflicting data are available regarding the effect of post-pancreatectomy complications on patient-reported HRQoL.

Methods: This is an observational cohort study including consecutive patients enrolled in a prospective clinical trial (NCT04431076) who underwent elective pancreatectomy (2020-2022). Before surgery and on postoperative days 15, 30, 90, and 180, patients completed the PROMIS-29 profile and Duke Activity Status Index questionnaires to assess their HRQoL and functional capacity. Mean differences in HRQoL scores were obtained using multivariable linear regression adjusting for preoperative scores and confounders.

Results: Of 528 patients, 370 (70%) experienced morbidity within 90 days, and 154 (29%) had severe complications (Clavien-Dindo grade >2). Delayed gastric emptying had the greatest impact on HRQoL, showing decreased mental health up to POD90 and physical health up to POD180 compared with uncomplicated patients. An inverse relationship between complication severity grade and HRQoL was evident for most domains, with Clavien-Dindo grade 3b to 4 patients showing worse HRQoL and functional capacity scores up to 6 months after surgery. In 235 pancreatic cancer patients, grade 3b and 4 complications were associated with reduced disease-specific survival (median 25 vs 41 mo, P <0.001).

Conclusions: In patients undergoing pancreatic resection, postoperative complications significantly impact all domains of patient quality of life with a dose-effect relationship between complication severity and impairment of HRQoL and functional capacity.

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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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