Trajectory of perioperative HRQOL and association with postoperative complications in thoracic surgery patients

Background: Patients undergoing thoracic surgery experience high rates of complications. A knowledge gap exists as to whether targeted pretreatment interventions can reduce complications. Health-related quality of life (HRQOL) could be used as a prognosticator for this purpose. The objectives of this study were to determine the perioperative trajectory of HRQOL and the association between pretreatment HRQOL and postoperative complications. Methods: A retrospective cohort study was performed using prospectively collected data. Consecutive patients seen at a tertiary thoracic clinic between January 2018 and January 2019 underwent longitudinal assessment of HRQOL using self-reported EuroQol 5-Dimension (EQ-5D) questionnaire scores. Postoperative complications were assessed using the Ottawa Thoracic Morbidity & Mortality System, prospectively with double adjudication. Multivariable logistic regression (generalized estimating equations with robust estimator) was used to determine the association between pretreatment EQ-5D scores and incidence of postoperative complications. Results: Among 515 patients analyzed, mean EQ-5D visual analogue scale (VAS) scores did not change significantly between clinic visits (p > 0.1). Time trend of VAS scores depicted no discernable trends. Changes in HRQOL dimension scores were seen in patients' usual activities only. During the first 2 clinic visits, the majority of patients had no problems with usual activities. In the third and fourth clinic visits, the majority of patients had at least some deficits in usual activities. Pretreatment EQ-5D VAS was independently associated with incidence of postoperative complications in the multi-variable analysis (p = 0.01). Conclusion: There are no obvious trends in the trajectory of perioperative HRQOL for patients undergoing thoracic surgery. Extended analysis should be conducted to identify subsets of patients who may experience worse HRQOL over time. This may be based on common phenotypes. Pretreatment HRQOL is associated with postoperative complications in patients undergoing thoracic surgery. Assessments of pretreatment HRQOL could be used to identify patients at higher risk for postoperative complications for whom targeted supportive interventions could be implemented.