Evaluación de la calidad de vida en el periodo postoperatorio inmediato en cirugía general / Quality of life measurement in the postoperative period in general and gastrointestinal surgery

Introducción: La calidad de vida relacionada con la salud es un resultado aceptado en cirugía para medir efectividad y para ajuste de riesgos, si bien su medición en el postoperatorio precoz ha presentado limitaciones. El propósito de este estudio es probar que es posible medir la calidad de vida relacionada con la salud en dicho periodo mediante un instrumento específico. Material y método: Se obtuvo un cuestionario específico estructurado en dominios con el uso consecutivo de 3 fuentes: la revisión bibliográfica, la entrevista con pacientes (n=30) y métodos de consenso Delphi con profesionales. Finalmente el instrumento es validado sometiéndolo a preprueba (n=36) y mediante un estudio clínico observacional prospectivo (n=250) analizando su capacidad de discriminar cohortes de pacientes por tipo de intervención, complicaciones, estado clínico, su evolución temporal y sus propiedades como medida, comparándolo con el short form-36. Resultados: El instrumento mostró buena sensibilidad al cambio y capacidad de discriminación para las diferentes cohortes de pacientes, además de facilidad de uso, alta coherencia interna (alfa de Cronbach 0,88), ausencia de redundancia entre dominios (rho de Spearman entre 0,29–0,84) y adecuada convergencia con la opinión de los pacientes. En cambio el short form-36 no mostró adecuada capacidad de discriminación, ni idoneidad para su uso en dicho periodo. Conclusiones: Estos resultados sugieren que el cuestionario elaborado es válido para evaluar la calidad de vida relacionada con la salud en el periodo postoperatorio inmediato, siendo más sensible y específico que el short form-36 (AU)

Introduction: Health related quality of life measurement (HRQL) is widely accepted as an appropriate outcome of surgical care for assessing effectiveness and for risk adjusted outcomes. Nevertheless its use in the immediate postoperative period has show limitations. The aim of this study is to prove that is possible, with a specific new tool, to assess the HRQL during this period. Patients and Methods: The study is designed to create a specific close questionnaire related to the patient's condition after surgery, structured in domains, with the subsequent use of: literature searches, patient interviews (n=30), and a Delphi survey with health care providers. Finally the tool was validated using a pre-test (n=36) and a prospective observational cohort trial (n=250), to assess the discriminant validity for different cohorts of patients, reliability, responsiveness, and convergent validity, and to compare with the widely used generic tool, Short Form 36 (SF-36). Results: The questionnaire was shown to have good sensitivity to change (single index and domains score), as well as good sensitivity to distinguish cohorts of patients, a high internal consistency (Cronbach's alpha 0.88), absence of redundancy between domains (Spearman's rho range, 0.29–0.84), and good convergent validity with patient opinion. The SF-36 questionnaire showed poor discriminant validity, and lack of convergent validity with patient opinion. Conclusions: These results support that the created questionnaire is appropriate to assess HRQL in the immediate postoperative period; and was more specific than SF-36 (AU)

[Quality of life measurement in the postoperative period in general and gastrointestinal surgery]. / Evaluación de la calidad de vida en el periodo postoperatorio inmediato en cirugía general.

INTRODUCTION: Health related quality of life measurement (HRQL) is widely accepted as an appropriate outcome of surgical care for assessing effectiveness and for risk adjusted outcomes. Nevertheless its use in the immediate postoperative period has show limitations. The aim of this study is to prove that is possible, with a specific new tool, to assess the HRQL during this period. PATIENTS AND METHODS: The study is designed to create a specific close questionnaire related to the patient's condition after surgery, structured in domains, with the subsequent use of: literature searches, patient interviews (n=30), and a Delphi survey with health care providers. Finally the tool was validated using a pre-test (n=36) and a prospective observational cohort trial (n=250), to assess the discriminant validity for different cohorts of patients, reliability, responsiveness, and convergent validity, and to compare with the widely used generic tool, Short Form 36 (SF-36). RESULTS: The questionnaire was shown to have good sensitivity to change (single index and domains score), as well as good sensitivity to distinguish cohorts of patients, a high internal consistency (Cronbach's alpha 0.88), absence of redundancy between domains (Spearman's rho range, 0.29-0.84), and good convergent validity with patient opinion. The SF-36 questionnaire showed poor discriminant validity, and lack of convergent validity with patient opinion. CONCLUSIONS: These results support that the created questionnaire is appropriate to assess HRQL in the immediate postoperative period; and was more specific than SF-36.