Measurement of Disability-Free Survival After Surgery

Abstract

A lthough patient survival and freedom from disability are important outcomes after surgery, it is unclear how postoperative disability should be measured. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS) was developed to measure disability cross-culturally, in the aged, and for diseaserelated states, and has been used to assess disability after trauma, stroke, spinal cord injury, and in various chronic diseases. However, it has not been specifically evaluated in a surgical setting. The current study evaluates WHODAS in a diverse surgical cohort with varying degrees of comorbid medical disease, disability, and health. In addition, it attempts to characterize disabilityfree survival after surgery.This multicenter prospective observational cohort study of more than 500 patients took place in 5 hospitals in Australia and Hong Kong. The authors examined the psychometric qualities of WHODAS, as well as assessed its clinical acceptability, validity, reliability, and responsiveness up to 12 months after surgery. Validity of WHODAS was tested by comparison to the 40-item quality of recovery score (QoR-40 score measuring the quality of recovery), EQ-SD scale (measuring quality of life), the Katz Index of Independence in Activities of Daily Living scale (Katz ADL scale, measuring physical functioning), and the modified Brief Pain Inventory Short Form (mBPI-SF, measuring daily pain). Patients were instructed to complete each of the above health status questionnaires, then were followed up with self-assessment questionnaires and by telephone at 30 days and 3, 6, and 12 months after surgery.WHODAS demonstrated good clinical acceptability, discriminative validity, reliability, scaling properties, and responsiveness to change. It showed moderate correlation with the Katz ADL scale and the QoR-40 score at all time points. WHODAS showed good correlation with the mBPI-SF pain scores and strong correlation with mean pain interference scores, which increased over time at day 30 and at 3, 6, and 12 months. Disability-free survival was 72%, 74%, 80%, and 76% at day 30 and at 3, 6, and 12 months, respectively. These results indicate that both postoperative disability/disability-free survival is an ideal study end point and that WHODAS is a valid and reliable instrument for the measure of disability in a surgical population.

A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

“…[1][2][3][4][5][6][7] The purpose of this review was to refocus on immediate clinical safety outcomes within 24 hours of anaesthesia ending. 8 There is a significant difference in outcome in developed and developing countries, and the contributory factors are highlighted in this regard.…”

Perioperative outcomes: Are we asking the right questions?

“…La survie sans invalidité (c'est-à-dire, une récupération à plus long terme sans invalidité). 9 Cette liste peut toutefois être allongée et interprétée de façon très large. De fait, les critères d'évaluation suivants des patients sont souvent mesurés dans les études périopératoires: la durée du séjour hospitalier et, pour les patients admis en unité de soins intensifs (USI), la durée de la ventilation mécanique et du séjour en USI.…”

“…Disability-free survival (i.e., longer term recovery free of disability). 9 The preceding list, however, can be extended and interpreted very broadly. Indeed, the following patient outcomes are frequently measured in perioperative studies: length of hospital stay and, for those admitted to the intensive care unit (ICU), duration of mechanical ventilation and ICU stay.…”

La standardisation des critères d’évaluation en recherche périopératoire

“…[24][25][26] Hence, there is a growing interest in short-term and longer term recovery endpoints to quantify the overall success of surgery. [27][28][29] Other controversies persist concerning measurement of adverse events. First, the definitions used for specific complications are frequently inconsistent.…”