title: Changes in quality of life after elective surgery: an observational study comparing two measures.
abstract: Our main objective was to compare the change in a validated quality of life measure to a global assessment measure. The secondary objectives were to estimate the minimum clinically important difference (MCID) and to describe the change in quality of life by surgical specialty.
  
  
  
  This prospective cohort study included 7902 adult patients undergoing elective surgery. Changes in the Veterans RAND 12-Item Health Survey (VR-12), composed of a physical component summary (PCS) and a mental component summary (MCS), were calculated using preoperative and postoperative questionnaires. The latter also contained a global assessment question for quality of life. We compared PCS and MCS to the global assessment using descriptive statistics and weighted kappa. MCID was calculated using an anchor-based approach. Analyses were pre-specified and registered (NCT02771964).
  
  
  
  By the change in VR-12 scores, an equal proportion of patients experienced improvement and deterioration in quality of life (28% for PCS, 25% for MCS). In contrast, by the global assessment measure, 61% reported improvement, while only 10% reported deterioration. Agreement with the global assessment was slight for both PCS (kappa = 0.20, 57% matched) and MCS (kappa = 0.10, 54% matched). The MCID for the overall VR-12 score was approximately 2.5 points. Patients undergoing orthopedic surgery showed the most improvement in quality of life measures, while patients undergoing gastrointestinal/hepatobiliary or urologic surgery showed the most deterioration.
  
  
  
  Subjective global quality of life report does not agree well with a validated quality of life instrument, perhaps due to patient over-optimism.
authors.affiliation: Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Kronzer
authors.affiliation: Department of Biostatistics, University of Michigan, 534 Canton Street, Canton, MI, 48188, USA.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Jerry
authors.affiliation: Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA.
authors.forename: Arbi
authors.initials: A
authors.lastname: Ben Abdallah
authors.affiliation: Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA.
authors.forename: Troy S
authors.initials: TS
authors.lastname: Wildes
authors.affiliation: Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: McKinnon
authors.affiliation: Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Anesthesia, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO, 63110, USA. avidanm@anest.wustl.edu.
authors.forename: Michael S
authors.identifier: 0000-0002-7489-3134
authors.initials: MS
authors.lastname: Avidan
mesh_terms: D015331:Cohort Studies; D004185:Disability Evaluation; D017558:Elective Surgical Procedures / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Elective surgical procedures; Minimum clinically important difference (MCID); Outcome assessment; Patient-reported outcomes; Quality of life