Is quality of life post cardiac surgery overestimated?
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RESEARCH
Open Access
Is quality of life post cardiac surgery overestimated? Luc Noyez
Abstract Background: Quality of Life (QoL) studies concerns the difference in QoL between the baseline and the post-surgical assessment. Many such studies, however, suffer from incomplete QoL-data with regard to patients with a proven survival - the drop-outs. Our hypothesis is that patients with a low preoperative QoL, high operative risk and older age are at higher risk for drop-out, which may result in a biased conclusion. Methods: This study includes 1675 patients, all of whom were operated between July 1, 2009 and July 1,2012 and have a proven one-year survival, as well as a complete preoperative EuroQoL registration (EQ-5D and EQ-VAS). Based on the calculated 30 and 70 percentiles of age, EuroSCORE risk, and EQ-5D and EQ-VAS values, the group was split into three different subgroups. We studied whether (1) there was a correlation between age, risk, preoperative QoL and postoperative QoL and (2) if the drop-outs were correlated to age, risk and preoperative QoL. Results: There is a statistically significant correlation between postoperative QoL and both age (p = 0.029) and risk (p = 0.002). Both relations have a negative Pearson’s r. There is also a statistically significant (p = 0.0001) correlation between pre- and postoperative QoL, now with a positive Pearson’s r. The percentage of drop-outs increases in a statistically significant manner with an increased risk (p = 0.001), older age (p = 0.001) and a low preoperative QoL (EQ-5D, p = 0.001 and EQ-VAS, p = 0.003). Conclusion: We conclude that QoL post cardiac surgery is overestimated, certainly for older, high risk patients and patients with a low preoperative QoL. Keywords: Quality of life, Cardiac surgery, Elderly, Risk
Background Over the past years, Quality of Life (QoL) has become an increasingly important aspect in medicine, social sciences and health care. Even evidence based medicine now attributes importance not only to the direct physical impact of the disease and the results of treatment, but also to a patient’s QoL. In the recently updated ESC/ EACTS guidelines on the management of valvular heart disease (version 2012) it is noted that ‘quality of life issues’ should be taken into account when deciding on the type of valve [1]. Several papers have already dealt with the evaluation of QoL post cardiac surgery, mostly with regard to elderly patients [2-5]. Here, QoL research concerns an evaluation of preoperative versus postoperative QoL. In a previous paper we have already called for Correspondence: [email protected] Heart Center, Radboud University Nijmegen Medical Center, Department of Cardio-Thoracic Surgery – 677, PO Box 9101, Nijmegen 6500 HB, Netherlands
consideration of data about demographics, co-morbidity and cardiac risk of patients who are excluded in QoL evaluation studies [6]. In this current study we focus on yet another group: patients with preoperative QoL information and a proven survival, but with a lack of or incomplete postoperative
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