title: Patient, operative, and surgeon factors that influence the effect of superficial venous surgery on disease-specific quality of life.
abstract: OBJECTIVE
  Superficial venous surgery for CEAP 2 disease leads to an improvement in disease-specific quality of life (QoL) in the short term. However, which factors influence the magnitude of this improvement, how surgery affects QoL in patients with CEAP 4 to 6 disease, and whether this improvement is durable are not known. The objective of this study was to identify patient, operative, and surgeon factors that might influence the change in disease-specific QoL in the 2 years after superficial venous surgery.
  
  
  METHODS
  This prospective study was comprised of 203 unselected, consecutive patients with CEAP 2 to 6 disease who underwent saphenous with or without subfascial endoscopic perforator surgery and who completed the Aberdeen Varicose Vein Symptoms Severity Score (AVVSSS) before surgery and at 4 weeks, 6 months, and 2 years after surgery. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  At baseline, recurrent and ulcer (CEAP 5 and 6) diseases were associated with a higher (worse) AVVSSS. Surgery was associated with a significant improvement in median (interquartile range [IQR]) AVVSSS: baseline, 17.8 (11.8 to 27.2); 4 weeks, 13.8 (7.9 to 21.3); 6 months, 9.6 (4.2 to 15.8); and 2 years, 8.1 (4.0 to 14.7). One hundred seventy-five patients (86%) at 6 months and 177 patients (87%) at 2 years reported an improvement in AVVSSS. Postoperative AVVSSS at both 6 months and 2 years was most significantly influenced by preoperative score (P <.0001). After adjustment for baseline AVVSSS, the following factors were identified in multivariate analysis as having a significant and independent positive (+) or negative (-) impact on AVVSSS: at 6 months, (-) recurrent disease (P =.009), (-) CEAP 4 disease (P =.026); and at 2 years, (+) long saphenous surgery (P =.02), (-) CEAP 5 disease (P =.030).
  
  
  CONCLUSIONS
  In this unselected series, saphenous surgery with or without subfascial endoscopic perforator surgery led to an improvement in disease-specific QoL in 87% of patients out to 2 years. Although univariate analysis results suggested that many baseline factors might be associated with outcome, multivariate analysis results suggested that only surgery for recurrent disease and for CEAP 4/5 disease remained as significant negative, and only long saphenous surgery as significant positive, independent prognostic factors. These data provide evidence of the medium-term clinical effectiveness of venous surgery across the full spectrum of CEAP clinical grades, show the importance of multivariate analysis, and reemphasize the importance of minimization of recurrence.
authors.affiliation: Department of Vascular Surgery, University of Birmingham, United Kingdom.
authors.forename: Rhoda K
authors.initials: RK
authors.lastname: Mackenzie
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.forename: Anna
authors.initials: A
authors.lastname: Paisley
authors.forename: Paul
authors.initials: P
authors.lastname: Burns
authors.forename: Paul L
authors.initials: PL
authors.lastname: Allan
authors.forename: C Vaughan
authors.initials: CV
authors.lastname: Ruckley
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Bradbury
mesh_terms: D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D012501:Saphenous Vein / Q000601:surgery; D013222:State Medicine; D006113:United Kingdom; D014648:Varicose Veins / Q000601:surgery*; D014652:Vascular Diseases / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000191:economics