title: Validity of the EuroQol-5 dimensions as a measure of recovery after pulmonary resection.
abstract: BACKGROUND
  Surgical innovations advocated to improve patient recovery are often costly. Economic evaluation requires preference-based measures that reflect the construct of patient recovery. We investigated the responsiveness and construct validity of the EuroQol-5 dimensions (EQ-5D) as a measure of postoperative recovery after planned pulmonary resection for suspected malignant tumors.
  
  
  METHODS
  Patients undergoing pulmonary resection completed the EQ-5D questionnaire and visual analog scales (VAS) for pain and fatigue at baseline (preoperatively) and at 1 and 3 mo postoperatively. Responsiveness and construct validity (discriminant and convergent) were investigated by testing a priori hypotheses.
  
  
  RESULTS
  Fifty-five patients were analyzed (45% male, 62 ± 12 y, 29% video-assisted). There was no significant difference between median EQ-5D scores obtained at baseline (0.83 [interquartile range {IQR 0.80-1}]) compared to scores at 1 mo (0.83 [0.80-1], P = 0.86) and 3 mo after surgery (1 [0.83-1]; P = 0.09). At 1 mo after surgery, EQ-5D scores were significantly lower in patients undergoing thoracotomy versus video-assisted surgery (0.82 [IQR 0.77-0.89] versus 1 [0.83-1], P = 0.003), but there were no significant differences between patients ≥ 70-y old versus younger (0.95 [IQR 0.82-1] versus 0.83 [0.77-1], P = 0.09) or between patients with versus without complications (0.82 [IQR 0.79-0.95] versus 0.83 [0.80-1], P = 0.10). There was a low but significant correlation between EQ-5D and VAS scores of pain and fatigue (Rho -0.30 to -0.47, P ≤ 0.01).
  
  
  CONCLUSIONS
  Despite evidence of convergent validity, the EQ-5D was not sensitive to the hypothesized trajectory of postoperative recovery and showed limited discriminant validity. This study suggests that the EQ-5D may not be appropriate to value recovery after lung resection.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Bejjani
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: Julio F
authors.initials: JF
authors.lastname: Fiore
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lee
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: Pepa
authors.initials: P
authors.lastname: Kaneva
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: Juan
authors.initials: J
authors.lastname: Mata
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: Annie
authors.initials: A
authors.lastname: Ncuti
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: Christian
authors.initials: C
authors.lastname: Sirois
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: David S
authors.initials: DS
authors.lastname: Mulder
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Ferri
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec. Electronic address: liane.feldman@mcgill.ca.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000367:Age Factors; D000368:Aged; D005221:Fatigue / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis*; D011013:Pneumonectomy; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D064232:Visual Analog Scale
keywords: EQ-5D; Lung cancer; Recovery; Thoracic surgery; Thoracotomy; Utility; Validity; Video-assisted thoracic surgery