BJS 1 The impact of postoperative complications on quality of life after major abdominal surgery: An analysis of the Perioperative Quality Improvement database

Abstract

Abstract Aims Postoperative complications are common, but there are limited data regarding their implications on patients’ quality of life. This work aimed to address this gap in the literature by analysing prospectively collected, high quality data to estimate the impact of postoperative complications on patients’ health-related quality of life. Methods Data from the Perioperative Quality Improvement Programme were analysed and included patient-level data for 19,685 adults who underwent elective major abdominal procedures in England since 2016. Postoperative complications were classified using the Clavien-Dindo classification system. Quality of life was assessed by responses to the EuroQol-5-dimension five-levels of response (EQ-5D-5L) questionnaire before surgery, and at 6 and 12 months post-surgery. Ordinal logistic regression estimated the association between Clavien-Dindo grades and quality of life. Results At six and twelve months post-surgery, increasingly severe postoperative complications were significantly associated with lower health-related quality of life. The effect of postoperative complications on quality of life was sustained until at least twelve months post-surgery. Between admission and twelve months post-surgery, 0.012, 0.026, 0.033, and 0.086 QALYs were lost for those experiencing a Grade I, II, III, or IV postoperative complication, respectively. Conclusions This is the first large-scale study of major abdominal surgery to evaluate the effect of postoperative complications on patients’ quality of life after surgery, and to provide utility values for postoperative complications using the Clavien-Dindo classification system. This work enables robust cost-utility analyses of interventions in future surgical research, and outlines the value case for research to predict, prevent and manage postoperative complications.