The Impact of Postoperative Complications on Recovery of Health-Related Quality of Life and Functional Capacity after Pancreatectomy: Findings From a Prospective Observational Study.

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.

Informations de copyright

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Déclaration de conflit d'intérêts

The authors report no conflicts of interest.