title: The impact of complications on quality of life following colorectal surgery: a prospective cohort study to evaluate the Clavien-Dindo classification system.
abstract: OBJECTIVE
  This prospective cohort study was performed to evaluate the impact of complications on quality of life (QOL) in colorectal surgery. The Clavien-Dindo complication classification (CDCC) is promising, but has not been evaluated by relating the classification to patient-reported outcome measures.
  
  
  METHODS
  Patients undergoing colorectal surgery were evaluated prospectively 12 months postoperatively using the WHOQOL-BREF questionnaire. Patient data were prospectively recorded and complications were classified using the CDCC. Postoperative QOL in patients with minor and severe complications and patients without complications was compared using a general linear model. Relationships between CDCC and QOL were examined using correlations and multivariate regression.
  
  
  RESULTS
  Of 218 patients, 130 (59.6%) had complications. In patients with severe complications there was a greater decrease in overall QOL (P = 0.043), QOL-physical (P < 0.001) and QOL-psychological (P = 0.013) domains in the first six postoperative weeks, whereas patients with minor complications had QOL scores comparable to those of patients without complications. QOL recovered to preoperative levels in all groups at 12 months. Change in QOL at 6 weeks was significantly correlated with CDCC grade, especially in the physical domain (Spearman's rho -0.287, P < 0.001). The presence of severe complications was an independent predictor of overall QOL, QOL-physical and QOL-psychological at 6 weeks.
  
  
  CONCLUSIONS
  Severe complications are associated with reduced postoperative QOL at 6 weeks, but QOL recovers after 12 months. CDCC grade negatively correlates with change in QOL in the early postoperative period. These findings support the theoretical framework of the CDCC.
authors.affiliation: Department of Surgery, Martini Hospital, Groningen, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Bosma
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Disease (CoRPS), Tilburg University, Tilburg, The Netherlands.
authors.forename: M J J
authors.initials: MJ
authors.lastname: Pullens
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Disease (CoRPS), Tilburg University, Tilburg, The Netherlands.|Department of Medical Psychology, St Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Disease (CoRPS), Tilburg University, Tilburg, The Netherlands.|Department of Medical Psychology, St Elisabeth Hospital, Tilburg, The Netherlands.|Department of Surgery, St Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Roukema
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011183:Postoperative Complications / Q000145:classification*; D011446:Prospective Studies; D011788:Quality of Life; D012002:Rectal Diseases / Q000601:surgery*; D011795:Surveys and Questionnaires
keywords: Clavien-Dindo classification; Quality of Life; colorectal surgery; complications