Postoperative Quality Of Life Outcomes Research Articles

Stratifying quality of life outcome in subthalamic stimulation for Parkinson’s disease

BackgroundSubthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson’s disease (PD) improves quality of life (QoL), motor and non-motor symptoms (NMS). However, in previous studies, 43%–49% of patients did not experience...

The Role of L1PA in Patient Reported Outcomes in Patients Undergoing Single Level Lumbar Fusion for Degenerative Spondylolisthesis.

Retrospective cohort study. To determine whether the L1 pelvic angle (L1PA) can be used to predict quality of life outcomes for adults one year after L4-L5 fusion to treat degenerative spondylolisthesis. L1PA is beneficial in the evaluation of pre and postoperative quality of life outcomes in patients undergoing surgery for spinal deformity. No studies have examined its utility in surgical patients with degenerative spinal disease. Patients undergoing L4-L5 posterolateral decompression and fusion or transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis were grouped by preoperative and postoperative L1PA, and further stratified by cut offs of>7.2° and <7.2° based on previous literature. We also stratified patients by presence of an ideal calculated L1PA, defined as (0.5xPelvic Incidence)-21 +/- 5°, as proposed by prior literature. Preoperative, one year postoperative and Δ (postoperative minus preoperative) patient reported outcome measures (PROMs) and radiographic measurements were collected. Twenty-four patients were identified with preoperative L1PAs <7.2° and 132 with L1PAs>7.2°. Eighteen patients were identified with postoperative L1PAs <7.2° and 138 with L1PAs>7.2°. Sixty-five and fifty-seven patients were identified as having ideal calculated pre and postoperative L1PAs, respectively. When using absolute cutoffs, L1PA correlated with pelvic tilt, pelvic incidence, and pelvic incidence-lumbar lordosis mismatch (PI-LL). When using calculated L1PAs, L1PA correlated with lumbar lordosis, PI-LL, pelvic tilt and sacral slope. With respect to PROMs, no statistically significant differences existed between cohorts both preoperatively and at 1 year postoperatively on either univariate and multivariate analyses. L1PA may be a helpful radiographic consideration that translates to clinically relevant outcomes in spinal deformity. However, it does not appear as predictive of patient outcomes after single level fusion for patients with L4-L5 degenerative spondylolisthesis. Further studies are warranted to investigate the role of L1PA in degenerative spine patients.

Analysis of the efficacy of separation surgery for severe neurological compression in multiple myeloma: a retrospective analysis of 35 cases.

To investigate the effectiveness and safety of separation surgery for Epidural Spinal Cord Compression (ESCC) graded ≥ 2 in patients with Multiple Myeloma (MM), analyze factors influencing surgical outcomes, and develop a preliminary treatment decision framework for these patients. A retrospective analysis was conducted on clinical data from 35 MM patients who underwent separation surgery for ESCC graded ≥ 2 between 2013 and 2018. Patient data, including baseline information, surgical details, complications, and pre-operative as well as one-month post-operative efficacyevaluationindicators were recorded. Statistical analysis was performed on pre-operative and post-operative efficacy indicators to determine if there were significant improvements (p < 0.05). Ordered logistic regression was utilized to assess factors associated with an unfavorable post-operative quality of life outcome. Compared to pre-operative values, at one-month post-surgery, patients showed significant improvements in Frankel Score Classification (4 vs 5, p < 0.05), Karnofsky Performance Score (30 vs 70, p < 0.05), and Visual Analogue Scale (8 vs 3, p < 0.05). Complications occurred in 7 cases (20%). The number of segments with ESCC (OR = 0.171, p < 0.05) and pre-operative chemotherapy (OR = 5.202, p = 0.05) were identified as independent factors influencing patient outcomes. Patients with more than two vertebral segments with ESCC exhibited significantly worse post-operative conditions. Separation surgery effectively alleviates pain, improves neurological function, and enhances the quality of life in patients with ESCC graded ≥ 2 due to MM.

The effect of bony obliteration on quality of life after tympano-mastoidectomy surgery: A prospective observational controlled cohort study.

The study's primary objective was to compare the quality of life (QoL) and external auditory canal (EAC) hygiene among patients who underwent bony mastoid obliteration or meatoplasty after canal wall down (CWD) mastoidectomy. A prospective, observational, controlled cohort study was conducted at our tertiary referral university hospital. Twenty-eight patients older than 16 years of age with chronic otitis media who underwent CWD mastoidectomy were included. Two cohorts were followed: CWD mastoidectomy followed by mastoid obliteration (Group 1, n = 14) and CWD mastoidectomy followed by meatoplasty (Group 2, n = 14). The main outcome measures of total COMBI score (postoperative 6-month QoL) and EAC hygiene were compared between the groups. The average age of the patients was 36.14 (12. 22) years; 15 (53.6%) were female and 13 (46.4%) were male. There were no differences in demographic variables, preoperative findings, or COMQ-12 (preoperative QoL) scores between groups. The average COMBI score of Group 1 (49.0 [8.66]) was not significantly different from Group 2 (46.79 [7.76]) (p = .482). Poor EAC hygiene was observed in eight (57.1%) patients in Group 2 and three (21.4%) patients in Group 1 (p = .06). In Group 1, no resorption of graft material was observed in 10 (71.4%) patients, minor resorption was observed in three (21.4%) patients, and significant resorption was observed in one (7.1%) patient. There were no significant differences in audiological findings between groups (p > .05). There were no significant differences regarding short-term postoperative QoL, EAC hygiene, or hearing outcomes between patients who underwent bony mastoid obliteration or meatoplasty after CWD mastoidectomy. 1b (individual prospective cohort study).

Adoption of otolaryngologist-head neck surgeons toward transoral robotic surgery: An international survey.

To investigate perception, adoption and awareness of otolaryngologist-head neck surgeons (OTO-HNS) toward transoral robotic surgery (TORS). An online survey was sent to 1383 OTO-HNS on the perception, adoption and awareness about TORS to members of many otolaryngological societies. The following aspects were assessed: TORS access; training; awareness/perception; indications and advantages/barriers to TORS practice. The responses were presented for the entire cohort and regarding the TORS experience of OTO-HNS. A total of 359 completed the survey (26%); including 115 TORS surgeons. TORS-surgeons carry out a mean number of 34.4 annual TORS procedures. The primary barriers to TORS were the cost of the robot (74%) and disposable accessories (69%), and the lack of training opportunity (38%). The 3D view of the surgical field (66%), the postoperative quality of life outcomes (63%) and the shorter hospital stay (56%) were the most important benefits of TORS. TORS-surgeons believed more frequently that TORS is indicated for cT1-T2 oropharyngeal and supraglottic cancers than non-TORS surgeons (p < .005). Participants believed that the priorities for the future consisted of the reduction of the robot arm size and the incorporation of flexible instruments (28%); the integration of laser (25%) or GPS tracking based on imaging (18%), all of them to improve accesses to hypopharynx (24%), supraglottic larynx (23%) and vocal folds (22%). The perception, adoption and knowledges toward TORS depend on the access to robot. The findings of this survey may help guide decisions on how improve the dissemination of TORS interest and awareness.

Iliac Artery Endofibrosis: Postoperative Quality of Life Outcomes for an Elusive Disease in High-Performance Athletes

We determined the diagnostic, surgical, and long-term quality of life outcomes for patients with iliac artery endofibrosis, an underrecognized disease that affects the performance and well-being of elite endurance athletes.

Postoperative outcomes after degenerative lumbar spine surgery in rheumatoid arthritis patients -a propensity score-matched analysis

BackgroundAlthough treatment options for rheumatoid arthritis (RA) have evolved significantly since the introduction of biologic agents, degenerative lumbar disease in RA patients remains a major challenge. Well-controlled comparisons between RA patients and their non-RA counterparts have not yet been reported. The objective of the present study was to compare postoperative outcomes of lumbar spine surgery between RA and non-RA patients by a retrospective propensity score-matched analysis.MethodsPatients who underwent primary posterior spine surgery for degenerative lumbar disease in our prospective multicenter study group between 2017 and 2020 were enrolled. Demographic data including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, diabetes mellitus, smoking, steroid usage, number of spinal levels involved, and preoperative patient-reported outcome (PRO) scores (numerical rating scale [NRS] for back pain and leg pain, Short Form-12 physical component summary [PCS], EuroQOL 5-dimension [EQ-5D], and Oswestry Disability Index [ODI]) were used to calculate a propensity score for RA diagnosis. One-to-one matching was performed and 1-year postoperative outcomes were compared between groups.ResultsAmong the 4567 patients included, 90 had RA (2.0%). RA patients in our cohort were more likely to be female, with lower BMI, higher ASA grade and lower current smoking rate than non-RA patients. Preoperative NRS scores for leg pain, PCS, EQ-5D, and ODI were worse in RA patients. Propensity score matching generated 61 pairs of RA and non-RA patients who underwent posterior lumbar surgery. After background adjustment, RA patients reported worse postoperative PCS (28.4 vs. 37.2, p = 0.008) and EQ-5D (0.640 vs. 0.738, p = 0.03), although these differences were not significant between RA and non-RA patients not on steroids.ConclusionsRA patients showed worse postoperative quality of life outcomes after posterior surgery for degenerative lumbar disease, while steroid-independent RA cases showed equivalent outcomes to non-RA patients.

Postoperative exercise training improves the quality of life in patients receiving pulmonary resection: A systematic review and meta-analysis based on randomized controlled trials

PurposeTo evaluate whether postoperative exercise training is effective in improving clinical outcomes such as the quality of life (QoL), exercise capacity and respiratory function of patients receiving pulmonary resection. Data sourcesThe PubMed, EMBASE, Web of Science and PEDro electronic databases were comprehensively searched to identify eligible randomized controlled trials (RCTs). MethodsThe PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The primary outcome was postoperative QoL and secondary outcomes were exercise capacity and respiratory function. ResultsA total of eight studies involving 691 participants were enrolled in this systematic review and meta-analysis. For the postoperative QoL measured by 36-Item Short Form Health Survey (SF-36), the pooled results demonstrated that postoperative exercise training could significantly improve the SF-36 physical domain score [weighted mean difference (WMD) = 5.87, 95% confidence interval (CI): 3.96 to 7.78, P＜0.001] and SF-36 mental domain score (WMD = 8.15, 95% CI: 0.13 to 16.16, P = 0.05). The results of further analysis for the eight dimensions of SF-36 were similar to the overall results. However, for secondary outcomes, no significant effects of postoperative exercise training on exercise capacity and respiratory function were observed. ConclusionPostoperative exercise training could significantly improve the QoL of patients undergoing lung surgery. However, more RCTs with large samples are still needed to verify the effects of postoperative exercise rehabilitation on clinical outcomes of patients who receive pulmonary resection.

Quality of life in vestibular schwannoma: a comparison of three surgical techniques.

Through years, interest in quality of life (QoL) among patients affected by vestibular schwannoma (VS) has increased. The expansion of the indications for endoscopic ear surgery allowed the development of the transcanal transpromontorial surgery (TTS) for VS removal. The objective of the present study was to assess QoL in a cohort of VS patients operated on by translabyrinthine (TL), retrosigmoid (RS) and TTS approach. The study was conducted on 111 patients who underwent surgery for VS between January 2017 and January 2020 at two different institutions. Patients fulfilled three questionnaires during follow-up: Glasgow Benefit Inventory, Depression Anxiety Stress Scales-21 and Penn Acoustic Neuroma Quality-Of-Life. The association between sex, age, date of surgery, tumor size, post-operative facial nerve (FN) function and QoL outcomes was assessed. An overall subjective impairment was demonstrated in all groups. Age, Koos staging and FN functions were associated to distinct QoL outcomes. QoL decreases in patients surgically treated for VS. The TTS may allow improved scores in many domains, confirming to be a subjectively well-tolerated technique.

Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients - a retrospective study.

Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated. To determine if preoperative nutritional status is associated with postoperative surgical and quality of life (QoL) outcomes after pelvic exenteration surgery. A retrospective cohort study was conducted at a quaternary hospital investigating 123 patients who had pelvic exenteration surgery from January 2017 to August 2019. Preoperative nutritional status and postoperative surgical and QoL outcomes were collected and analysed to determine any associations. Overall, 49.6% of patients were female with a median age of 59 years. Forty patients (32.5%) were malnourished and 83 (67.5%) were well nourished before surgery. Well-nourished patients had a shorter length of hospital stay (p = 0.034) and at 6 months post-surgery, presented with a significantly better physical and mental QoL score (p = 0.038 and p = 0.001 respectively). The regression analyses showed that intensive care unit (ICU) readmission rates were 7.19 times more likely to occur in malnourished patients (p = 0.022). Preoperative malnutrition is associated with increased length of stay, ICU readmissions and poorer QoL following pelvic exenteration. Nutrition screening, assessment and optimisation of management are essential in this patient cohort to improve patient outcomes. Future studies are needed to measure the effect of interventions and identify the most beneficial model of care for this complex patient group.

Inguinal hernia mesh is safe in 1720 patients

There is substantial media and patient interest in the safety of mesh for hernia repair. However, there is a lack of data regarding health-related quality of life (HRQOL) outcomes in patients who undergo inguinal hernia repair (IHR) with mesh. The purpose of this study is report short and long-term postoperative quality of life outcomes in patients following IHR with mesh. We analyzed outcomes of 1720 patients who underwent IHR with mesh between 2008 and 2019 at a single institution from a prospectively maintained quality database. All surgeries were performed by four board-certified surgeons. HRQOL outcomes were measured using the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys that were administered preoperatively, 3weeks, 6months, 1, 2, and 5years postoperatively. Survey responses were summarized as mean with standard deviation or frequency with percentage. Postoperative SOMS scores were compared to preoperative scores using the two-tailed paired t test with a significance level of p < 0.05. One (0.1%) patient experienced a mesh infection postoperatively. In terms of complications, 159 (9.2%) developed a seroma, 31 (1.8%) a hematoma, and 36 (2.1%) patients experienced a recurrence. SOMS Pain Impact, SOMS Pain Quality, and SOMS Pain visual analog scale at 3weeks, 6months, 1year, 2years, and 5years were all improved from preoperative (all p < 0.05). At 5years postoperatively, only 3.9%, 3.2%, and 3.1% of patients reported severe or disabling sensation of mesh, pain, and movement limitations, respectively. Inguinal hernia repair with mesh results in a low rate of complications. A minority of patients had severe or disabling symptoms at 5-year follow-up and generally reported improvements in pain impact and quality in long-term follow-up.

Patient-specific prediction model for clinical and quality-of-life outcomes after lumbar spine surgery.

Patient demographics, comorbidities, and baseline quality of life (QOL) are major contributors to postoperative outcomes. The frequency and cost of lumbar spine surgery has been increasing, with controversy revolving around optimal management strategies and outcome predictors. The goal of this study was to generate predictive nomograms and a clinical calculator for postoperative clinical and QOL outcomes following lumbar spine surgery for degenerative disease. Patients undergoing lumbar spine surgery for degenerative disease at a single tertiary care institution between June 2009 and December 2012 were retrospectively reviewed. Nomograms and an online calculator were modeled based on patient demographics, comorbidities, presenting symptoms and duration of symptoms, indication for surgery, type and levels of surgery, and baseline preoperative QOL scores. Outcomes included postoperative emergency department (ED) visit or readmission within 30 days, reoperation within 90 days, and 1-year changes in the EuroQOL-5D (EQ-5D) score. Bootstrapping was used for internal validation. A total of 2996 lumbar surgeries were identified. Thirty-day ED visits were seen in 7%, 30-day readmission in 12%, 90-day reoperation in 3%, and improvement in EQ-5D at 1 year that exceeded the minimum clinically important difference in 56%. Concordance indices for the models predicting ED visits, readmission, reoperation, and dichotomous 1-year improvement in EQ-5D were 0.63, 0.66, 0.73, and 0.84, respectively. Important predictors of clinical outcomes included age, body mass index, Charlson Comorbidity Index, indication for surgery, preoperative duration of symptoms, and the type (and number of levels) of surgery. A web-based calculator was created, which can be accessed here: https://riskcalc.org/PatientsEligibleForLumbarSpineSurgery/. The prediction tools derived from this study constitute important adjuncts to clinical decision-making that can offer patients undergoing lumbar spine surgery realistic and personalized expectations of postoperative outcome. They may also aid physicians in surgical planning, referrals, and counseling to ultimately lead to improved patient experience and outcomes.

Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Early Results from a Prospective Cohort Study of 115 Patients.

This study aimed to describe short- and medium-term longitudinal quality-of-life (QoL) outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Consecutive patients undergoing CRS and HIPEC were recruited. The primary outcome was QoL, measured using the short-form 36 questionnaire and expressed as a physical component score (PCS) and a mental component score (MCS), with higher scores representing better QoL. Data were collected prospectively at baseline and before discharge, then 3, 6, and 12months postoperatively. Trajectories of the PCS and MCS were described for the study period and grouped according to a peritoneal carcinomatosis index (PCI) (≤ 12 vs. ≥ 13) and a completeness of cytoreduction (CC) score (CC0 vs. CC1-CC3). Overall, 117 patients underwent CRS and HIPEC and 115 (98.3%) of the 117 patients participated in the study. The main primary pathology was colorectal in 52 (45%) of the 115 patients and appendiceal in 27 (23.5%) of the 115 patients. The median baseline PCS [48.16; interquartile range (IQR), 38.6-54.9] had decreased at pre-discharge (35.34; IQR, 28.7-41.8), then increased slightly at 3months (42.54; IQR, 37.6-51.6), before returning to baseline within 6months (48.35; IQR, 39.1-52.5) and remaining unchanged 12months after surgery (48.55; IQR, 40.8-55.5). The MCS remained unchanged during the study period. The patients with a PCI of 13 or higher had worse PCS and MCS during the postoperative period than the patients with a PCI of 12 or lower. The CRS and HIPEC procedures impaired PCS, with scores returning to baseline within 6months after surgery, whereas MCS remained unchanged. The patients with a lower PCI had better postoperative QoL outcomes. For patients with peritoneal malignancy, CRS and HIPEC can be performed with acceptable short- to medium-term QoL outcomes.

Age-related outcomes in laparoscopic hiatal hernia repair: Is there a "too old" for antireflux surgery?

Minimally invasive antireflux surgery has been shown to be safe and effective for the treatment of gastroesophageal reflux (GERD) in elderly patients. However, there is a paucity of data on the influence of advanced age on long-term quality of life (QoL) and perioperative outcomes after laparoscopic antireflux surgery (LARS). A retrospective study of patients undergoing LARS between February 2012 and June 2018 at a single institution was conducted. Patients were divided into four age categories. Perioperative data and quality of life (QOL) outcomes were collected and analyzed. A total of 492 patients, with mean follow-up of 21months post surgery, were included in the final analysis. Patients were divided into four age-determined subgroups (< 50:75, 50-65:179, 65-75:144, ≥ 75:94). Advancing age was associated with increasing likelihood of comorbid disease. Older patients were significantly more likely to require Collis gastroplasty (OR 2.09), or concurrent gastropexy (OR 3.20). Older surgical patients also demonstrated increased operative time (ß 6.29, p < .001), length of hospital stay (ß 0.56, p < .001) in addition to increased likelihood of intraoperative complications (OR 2.94, p = .003) and reoperations (OR 2.36, p < .05). However, postoperative QoL outcomes and complication rates were parallel among all age groups. Among older patients, there is a greater risk of intraoperative complications, reoperation rates as well as longer operative time and LOS after LARS. However, a long-term QoL benefit is demonstrated among elderly patients who have undergone this procedure. Rather than serving as an exclusion criterion for surgical intervention, advanced age among chronic reflux patients should instead represent a comorbidity addressed in the planning stages of LARS.

Prospective Randomized Controlled Study to Compare the Outcome of Standard 4-Port Laparoscopic Cholecystectomy with Single-Incision Laparoscopic Cholecystectomy in Patients with Gallstone Disease

Four-port laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder disease. To reduce the invasiveness of standard four-port laparoscopic cholecystectomy, single-incision laparoscopic cholecystectomy (SILC) has come about an attractive option for the performance of laparoscopic cholecystectomy. There have been no studies on SILC from Indian subcontinent. The present study was designed to compare the outcomes of SILC with the standard four-port LC in a prospective randomized controlled trial. All patients with symptomatic gallstone disease were evaluated between May 2012 and April 2014. Patients were randomized to either standard four-port laparoscopic cholecystectomy (LC group) or single-incision laparoscopic cholecystectomy (SILC group). Demographic profile, preoperative and intraoperative variables, postoperative complications, hospital stay, and pain scores were recorded. WHO-QOL BREF was used for quality of life analysis. Patients were followed up at regular intervals, and satisfaction scores were recorded. Statistical analysis was done using STATA 12 and p value < 0.05 was considered significant. Out of 94 patients, 90 received the intended treatment, and four cases in SILC group were converted to standard four-port cholecystectomy. The demographic profile and preoperative WHO-QOL BREF scores were comparable between the two groups. Severity of adhesions, successful dissection of Calot’s triangle, ergonomics, and overall level of difficulty were also comparable. Operation time was significantly higher in SILC group, but the learning curve was seen to be achieved after 30–35 cases. There was no significant difference in the incidence of immediate postoperative and chronic pain over a mean follow-up of 6 months except for pain score during normal activity in immediate postoperative period which was significantly higher in SILC group. Overall complication rate was significantly higher in SILC group, however the incidence of SSI was not found to be significant among the two groups. There was one case of transient bile leak and one case of intra-abdominal bleeding due to slippage of cystic artery clip. Postoperative quality of life outcomes were similar in the two groups. Although not significant, patients with SILC group had higher cosmetic score compared with the LC group. In conclusion, this study shows that SILC is a safe and feasible with a higher rate of complications but comparable cosmetic and QoL outcomes when compared with standard 4-port cholecystectomy.

Quality of life and emotional burden after transnasal and transcranial anterior skull base surgery.

To analyze psychopathological outcome and health-related quality of life (QOL) for cohorts of patients undergoing transcranial or transnasal anterior skull base surgery. A prospective study of patients undergoing elective surgery for various entities of the anterior skull base was performed. Evaluation for depression (ADS-K score) and anxiety (PTSS, STAI-S, STAI-T, and ASI-3 scores) was done before surgery, at 3 and 12months after surgery. The correlation between preoperative psychological burden and postoperative quality of life as measured by the SF-36 and EuroQol questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined and compared between transnasal and transcranial subgroups. We included 54 patients scheduled for surgery of a pituitary adenoma or meningioma of the anterior skull base between January 2013 and July 2017. Of these, a cohort of 40 (74.1%) completed follow-up interviews after 3 and 12months. There were 60.0% female patients, median age was 57years. 57.5% of patients had a meningioma and were operated transcranially, while 42.5% of patients received transnasal surgery for pituitary adenoma. The proportion of pathological anxiety scores significantly decreased from 75.0 to 45.0% (p = 0.002), without difference between transnasal and transcranial subgroups. After 3months, mean EuroQol VAS score non-significantly increased by 0.07 (p = 0.236) across the entire cohort without significant difference between transcranial and transnasal subgroups (p = 0.478). The transnasal cohort tended to score higher in anxiety scores, whereas the transcranial cohort demonstrated higher depression scores without significant difference, respectively. The individually declared emotional burden significantly decreased from 6.7 to 4.0 on the ten-point Likert scale (p < 0.001) equally for both subgroups (transnasal, - 2.3; transcranial, - 3.0; p = 0.174). On last examination, about half of the patients in each subgroup (41.2% vs. 52.2%; p = 0.491) expressed a considerable recovery of preoperative bodily complaints such as headaches, dizziness, and unrest defined as a score of at least 8 on the Likert scaled item. Both transnasal and transcranial approaches yield favorable postoperative QOL and psychopathological outcomes. The postoperative increase in QOL is partly influenced by preoperative expression of mental distress, which tends to resolve postoperatively.

Quality of life outcomes following velopharyngeal insufficiency surgery

ObjectivesVelopharyngeal insufficiency (VPI) may be due to functional or anatomic causes, and can lead to speech deficits, communication difficulty, and emotional strain on patients and their caregivers. The VPI Effects on Life Outcomes (VELO) instrument quantifies quality of life outcomes in VPI patients both before and after VPI surgery. This study aims to identify pre-operative patient characteristics associated with better post-operative quality of life. MethodsThis study is a retrospective chart review of 51 patients who underwent VPI surgery between 2009 and 2018 at a tertiary free-standing children's hospital. A 26-item parent-proxy VELO questionnaire was administered by telephone to parents to assess their child's quality of life post-VPI surgery. ResultsTwenty-seven parents responded to the VELO questionnaire. Average post-operative VELO score was significantly higher in non-syndromic patients as compared with syndromic patients. Average post-operative VELO score was not significantly different between patients with and without submucous cleft (SMC) or those with mild to moderate versus severe pre-operative hypernasality. On multivariate analysis, absence of genetic syndrome, lack of submucous cleft, and presence of severe-pre-operative hypernasality were significantly and positively associated with increased post-operative VELO scores. ConclusionChildren who undergo VPI surgery are more likely to have better post-operative quality of life outcomes if their VPI was not associated with a genetic syndrome or submucous cleft. Non-syndromic and non-SMC patients with severe pre-operative hypernasality may benefit significantly from VPI surgery and have improved post-operative quality of life.

MP54-07 CRYOPRESERVED PLACENTAL TISSUE ALLOGRAFT ACCELERATES TIME TO CONTINENCE AFTER ROBOTIC RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES:Urinary continence (UC) after robotic radical prostatectomy (RARP) represents, arguably, the higher priority post-operative quality of life outcome for most men. Data on...

Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery.

Whether for research or quality improvement, assessment of postoperative quality of life outcomes faces a challenge in reliable data collection. Typical coordinator-led studies cite response rates from 35% to 70%. This study evaluates the utility of a digital patient engagement platform to track patient-reported outcome measures (PROMs) following septoplasty and functional endoscopic sinus surgery (FESS). A prospective cohort was recruited at a tertiary care center from January 2017 to March 2018. A mobile phone application relayed PROMs, including pain (assessed on a 0 to 10 visual analogue scale [VAS] every other day for 2 weeks, as well as the patient-reported outcome measure information system [PROMIS] pain interference short form 4a at baseline, 2 weeks, and 3 months) and timing of return to work. Of 288 patients enrolled, 249 (86.5%) provided clinical data, including 208 who underwent septoplasty or FESS. Granular VAS scores, submitted by 195 patients, demonstrated 80% of these patients achieved minimal pain by postoperative day 8. A nonsignificant trend of increased days to pain relief by procedure emerged: septoplasty (mean ± standard deviation [SD], 3.60 ± 2.44), FESS (3.96 ± 3.25), FESS with septoplasty (4.40 ± 3.04), and FESS with drilling (4.86 ± 3.68). Across procedures, PROMIS pain interference increased at 2 weeks (9.17 ± 4.15) and decreased at 3 months (5.32 ± 2.61) compared with baseline (7.09 ± 4.63), with greater improvement noted in the FESS subgroup at 3 months. Patients returned to work at mean 7.1 days regardless of procedure. With its high response rate, mobile digital patient engagement platforms may effectively track postoperative outcomes with the potential for reduced sample bias.

Preoperative Nomograms Predict Patient-Specific Cervical Spine Surgery Clinical and Quality of Life Outcomes.

Clinical and quality of life (QOL) outcomes vary depending on the patient's demographics, comorbidities, presenting symptoms, pathology, and surgical treatment used. While there have been individual predictors identified, no comprehensive method incorporates a patient's complex clinical presentation to predict a specific individual postoperative outcome. To create tool that predicts patient-specific outcomes among those undergoing cervical spine surgery. A total of 952 patients at a single tertiary care institution who underwent anterior or posterior cervical decompression/fusion between 2007 and 2013 were retrospectively reviewed. Outcomes included postoperative emergency department visit or readmission within 30 d, reoperation within 90 d for infection, and changes in QOL outcomes. Nomograms were modeled based on patient demographics and surgical variables. Bootstrap was used for internal validation. Bias-corrected c-index for emergency department visits, readmission, and reoperation were 0.63, 0.78, and 0.91, respectively. For the QOL metrics, the bias-corrected adjusted R-squared was EQ-5D (EuroQOL): 0.43, for PHQ-9 (Patient Health Questionnaire-9): 0.35, and for PDQ (Pain/Disability Questionnaire): 0.47. Variables predicting the clinical outcomes varied, but included race and median income, body mass index, comorbidities, presenting symptoms, indication for surgery, surgery type, and levels. For the QOL nomograms, the predictors included similar variables, but were significantly more affected by the preoperative QOL of the patient. These prediction models enable referring physicians and spine surgeons to provide patients with personalized expectations regarding postoperative clinical and QOL outcomes following a cervical spine surgery. After appropriate validation, use of patient-specific prediction tools, such as nomograms, has the potential to lead to superior spine surgery outcomes and more cost effective care.