Systematic review of the impact of surgical harm on quality of life after general and gastrointestinal surgery.
OBJECTIVE
To assess the impact of surgical harm on quality of life (QoL) in general and gastrointestinal surgery.


BACKGROUND
Surgical adverse events (SAEs) are associated with poor outcome. Although SAEs are likely to affect QoL, this has not been demonstrated in surgery.


METHODS
Studies in general and gastrointestinal surgery measuring postoperative QoL in patients who suffered SAEs were identified. The overall impact of SAEs on QoL scores was determined by combining results from different studies. Component scores, adjustment for confounders, and time trends were evaluated.


RESULTS
Data from 57,058 patients in 31 studies were analyzed. Most studies assessed the combined effect of different SAEs. High-quality studies adjusted for preoperative QoL. When different QoL instruments were scaled down to a common 0 to 1 score, the mean difference in QoL between SAE and no-SAE patients was 0.140 in esophagectomy, 0.110 in the Crohn resection, 0.089 in colorectal resection, 0.085 in gastric bypass, 0.072 in cholecystectomy, and 0.060 in inguinal hernia repair. Studies evaluating ileal pouch formation and antireflux surgery showed conflicting results. SAEs did not significantly affect QoL in emergency laparotomy and pancreatectomy. The frequency of SAEs was 5% to 48%. Physical QoL was affected more than emotional QoL.


CONCLUSIONS
Significantly negative effects of SAEs on QoL were demonstrated in a range of procedures. Postoperative QoL seems to be a surrogate for the severity of impact of SAEs on patients. QoL may be an important utility to evaluate the economic and societal impact of SAEs thereby defining the threshold for safe practice.
Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, United Kingdom.
George
G
Bouras
Elaine Marie
EM
Burns
Ann-Marie
AM
Howell
Nigel Mark
NM
Bagnall
Henry
H
Lee
Thanos
T
Athanasiou
Ara
A
Darzi
D004066:Digestive System Diseases / Q000523:psychology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008318:Malpractice; D011183:Postoperative Complications / Q000523:psychology*; D011788:Quality of Life