The relationship of two postoperative complication grading schemas with postoperative quality of life after elective colorectal surgery

• Published in: Surgery Vol. 166; no. 4; pp. 663 - 669
• Main Authors: Dumitra, Teodora C., Trepanier, Maude, Fiore, Julio F., Kaneva, Pepa, Carli, Franco, Fried, Gerald M., Feldman, Liane S., Lee, Lawrence
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2019
• Subjects: Aged; Cohort Studies; Colorectal Surgery - adverse effects; Colorectal Surgery - methods; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - methods; Female; Follow-Up Studies; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; Patient Reported Outcome Measures; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Quality of Life; Retrospective Studies; Risk Assessment; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2019.05.058

Several grading schemes are available to assess surgical complications, but their relationship with patient-reported outcomes is not well understood. Therefore, our objective was to examine the effect of two complication grading schemas on health-related quality of life in colorectal surgery patients.
An analysis of adult patients undergoing elective colorectal surgery from 2005 to 2013 was performed. Health-related quality of life was measured using the SF-36 preoperatively and at 4 weeks and 8 weeks postoperatively. The 30-day morbidity was classified using Clavien-Dindo grading (I–IV) and the Comprehensive Complication Index (0–100). The main outcomes were the postoperative changes in physical summary scores and mental summary scores. Multivariate logistic and fractional polynomial regression analyses were used to determine the relationship between complication severity and health-related quality of life.
A total of 402 patients were included in the study. Overall morbidity was 46%. Patients with complications had lower physical summary scores and mental summary scores at 4-weeks and 8-weeks postoperatively compared with patients without complications (P < .05). On multivariate regression, there was no dose-response relationship between Clavien-Dindo grade and postoperative physical summary scores and mental summary scores. Adjusted changes in the physical summary scores and mental summary scores had a more appropriate, dose-response relationship with the Comprehensive Complication Index scores.
In patients undergoing colorectal surgery, there is a more consistent relationship between the Comprehensive Complication Index and postoperative health-related quality of life compared with the Clavien-Dindo classification.