Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory.
Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory.
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DOI：
10.1016/j.jtcvs.2015.05.057
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Wang XS
中科院分区：
文献类型：
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作者：
Fagundes CP;Shi Q;Vaporciyan AA;Rice DC;Popat KU;Cleeland CS;Wang XS
测量患者报告的结果(PRO)对于评估护理质量和指导患者管理变得越来越重要。然而，PROS尚未与传统的临床结果(如住院时间)相结合来评估围手术期护理。这项研究旨在利用纵向PRO评估来确定接受开胸肺癌手术患者的术后症状恢复轨迹。新诊断的I期或II期非小细胞肺癌患者(N=60)，接受了标准开胸手术或电视胸镜手术(VATS)肺叶切除术，使用MD Anderson症状清单(MDASI)报告了从术前到术后3个月的多种症状。我们进行了Kaplan-Meier分析，以确定症状在恢复期间何时恢复到术前水平和轻度严重水平。术后最严重的症状是乏力、疼痛、呼吸急促、睡眠障碍和嗜睡。这5种症状恢复到轻度症状严重程度的中位时间比恢复到基线严重程度的时间要短，而疲劳需要更长的时间。与标准开胸手术相比，接受VATS肺叶切除术的患者疼痛恢复更快(分别为8天和18天；P=.022)。术前表现不佳或合并并发症的患者报告的术后疼痛较高(均P<；0.05)。从患者的角度评估整个术后恢复期的症状是评估围手术期护理的有效策略。这项研究表明，MDASI是一种检测症状恢复的敏感工具，手术类型、术前表现状态和合并情况之间存在预期的关系。
Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay) to evaluate perioperative care. This study aimed to utilize longitudinal PRO assessments to define the postoperative symptom-recovery trajectory in patients undergoing thoracic surgery for lung cancer. Newly diagnosed patients (N=60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery (VATS) lobectomy reported multiple symptoms from presurgery to 3 months postsurgery using the MD Anderson Symptom Inventory (MDASI). We conducted Kaplan–Meier analyses to determine when symptoms returned to presurgical levels and to mild severity levels during recovery. The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than return to baseline severity, with fatigue taking longer. Pain recovered more quickly for patients who underwent VATS lobectomy vs standard open thoracotomy (8 days vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05). Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MDASI is a sensitive tool for detecting symptomatic recovery with an expected relationship among surgery type, preoperative performance status, and comorbid conditions.