The Impact of Postoperative Complications on Recovery of Health-Related Quality of Life and Functional Capacity after Pancreatectomy

医学 胰腺切除术 生活质量(医疗保健) 并发症 混淆 胃排空 健康相关生活质量 观察研究 外科 远端胰腺切除术 胰腺癌 前瞻性队列研究 胃轻瘫 队列 队列研究 疾病 癌症 内科学 切除术 护理部
作者
Nicolò Pecorelli,Giovanni Guarneri,Francesca Di Salvo,Alessia Vallorani,Chiara Limongi,Gianluca Corsi,Giulia Gasparini,Martina Abati,Stefano Partelli,Stefano Crippa,Massimo Falconi
出处
期刊:Annals of Surgery [Ovid Technologies (Wolters Kluwer)]
标识
DOI:10.1097/sla.0000000000006472
摘要

Objective: To evaluate the extent to which postoperative complications impact on patient health-related quality of life (HRQoL) and survival after pancreatic surgery. Summary Background Data: 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 (PODs) 15, 30, 90, 180, patients completed 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, 154 (29%) 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 to uncomplicated patients. An inverse relationship between complication severity grade and HRQoL was evident for most domains, with Clavien-Dindo grade 3b-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 versus 41 mo, P <0.001). Conclusion: In patients undergoing pancreatic resection, postoperative complications significantly impact on 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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