Faculty Collaboration Database

Are Patient-reported Outcomes Correlated With Clinical Outcomes After Surgery?: A Population-based Study. Ann Surg 2016 Oct;264(4):682-9

Date

09/10/2016

Pubmed ID

27611481

DOI

10.1097/SLA.0000000000001852

Scopus ID

2-s2.0-84988521353 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

OBJECTIVE: To evaluate the extent to which patient-reported outcomes (PROs) (eg, health-related quality of life) are distinct from clinical outcomes following bariatric surgery.

BACKGROUND: Hospital quality measurement often focuses on traditional clinical outcomes (eg, complications). However, PROs may provide a unique perspective regarding performance, particularly for common, low-risk procedures.

METHODS: We used data from 11,420 patients who underwent bariatric surgery (2008-2012) from the Michigan Bariatric Surgery Collaborative (39 hospitals). We included both short-term (30-day complication rates) and long-term (1-year weight loss and comorbidity resolution) outcomes. For PROs, we used health-related quality of life assessed by the Health and Activities Limitations Index (HALex) and Bariatric Quality of Life (BQL) index preoperatively and at 1 year. We used multivariable linear regression to determine the association between these PROs and both short and long-term clinical outcomes, adjusting for patient factors and the type of surgical procedure.

RESULTS: After adjustment for risk factors and surgical procedure, hospital rankings based on PROs (either the average change in HALex or BQL scores) were not correlated with hospital rankings based on complications. In contrast, both PRO measures were correlated with weight loss. Specifically, the average change in HALex score (R = 0.24, P < 0.002) and average change in BQL score (R = 0.44, P < 0.001) were correlated with hospital average percent excess. One PRO measure-BQL score-was correlated with a decline in the need for medications due to associated comorbidities (R = 0.16, P < 0.01). After accounting for short and long-term clinical outcomes, between 15% and 44% of the variation in PROs remained unexplained at the hospital level.

CONCLUSIONS: Patient-reported outcomes are not correlated with early perioperative events, but are correlated with measures of clinical effectiveness after bariatric surgery. A comprehensive approach to surgical quality should incorporate both clinical events and self-reported measures of health status throughout the short and long-term recovery period.

Author List

Waljee JF, Ghaferi A, Cassidy R, Varban O, Finks J, Chung KC, Carlozzi NE, Dimick JB

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Bariatric Surgery
Cohort Studies
Female
Humans
Male
Middle Aged
Obesity, Morbid
Patient Reported Outcome Measures
Quality of Life
Reproducibility of Results
Time Factors
Treatment Outcome
Weight Loss