title: Intestinal Surgery for Crohn’s Disease: Predictors of Recovery, Quality of Life, and Costs The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Perceived stress and cortisol levels predict speed of wound healing in healthy male adults Assessing patient-reported outcomes of cholecystectomy in short-stay surgery The Association Between Early Outcome, Health-Related Quality of Life, and Survival Following Elective Open-Heart Surgery Beneficial effect of inguinal hernioplasty on testicular perfusion and sexual function Quality of life after liver resection for hepatobiliary malignancies Perioperative myocardial infarction has negative impact on health-related quality of life following coronary artery bypass graft surgery. The negative effects of surgery persist beyond the early postoperative period after laparoscopic colorectal resection Predictors of Postoperative Quality of Life after Surgery for Lung Cancer Quality of Life After Laparoscopic Gastric Banding: Prospective Study (152 Cases) With a Follow-up of 2 Years Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemia. Quality of life improves within 30 days of surgery for Crohn's disease. Long‐term outcome of patients who require renal replacement therapy after cardiac surgery Relation between Quality of Recovery in Hospital and Quality of Life at 3 Months after Cardiac Surgery Publication bias in clinical research Chronic postthoracotomy pain and health-related quality of life. Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn? Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis.
abstract: Introduction The aim of this prospect i ve study was to analyze the impact of different surgical techniques on patients undergoing intestinal surgery for Crohn ’s disease ( CD ) in terms of recovery , quality of life , and direct and indirect costs . Patients and methods Forty-seven consecutive patients admitted for intestinal surgery for CD were enrolled in this prospect i ve study . Surgical procedures were evaluated as possible predictors of outcome in terms of disability status ( Barthel ’s Index ) , quality of life ( Clevel and Global Quality of Life score ) , body image , disease activity ( Harvey – Bradshaw Activity Index ) , and costs ( calculated in 2008 Euros ) . Univariate and multivariate analyses were performed . Results Significant predictors of a long postoperative hospital stay were the creation of a stoma , postoperative complications , disability status on the third post-operative day , and surgical access ( R2 = 0.59 , p < 0.01 ) . Barthel ’s index at discharge was independently predicted by laparoscopic-assisted approach , ileal CD , and colonic CD ( R2 = 0.53 , p < 0.01 ) . The disability status at admission showed to be an independent predictor of quality of life score at follow-up . The overall cost for intestinal surgery  for CD was 12,037 ( 10,117–15,795 ) euro per patient and stoma creation revealed to be its only predictor ( p = 0.006 ) . Conclusions Laparoscopy was associated with a shorter postoperative length of stay ; stoma creation was associated with a long and expensive postoperative hospital stay , and stricturoplasty was associated with a slower recovery of bowel function BACKGROUND Despite more than three decades of research on iatrogenesis , surgical adverse events have not been subjected to detailed study to identify their characteristics . This information could be invaluable , however , for guiding quality assurance and research efforts aim ed at reducing the occurrence of surgical adverse events . Thus we conducted a retrospective chart review of 15,000 r and omly selected admissions to Colorado and Utah hospitals during 1992 to identify and analyze these events . METHODS We selected a representative sample of hospitals from Utah and Colorado and then r and omly sample d 15,000 nonpsychiatric discharges from 1992 . With use of a 2-stage record- review process modeled on previous adverse event studies , we estimated the incidence , morbidity , and preventability of surgical adverse events that caused death , disability at the time of discharge , or prolonged hospital stay . We characterized their distribution by type of injury and by physician specialty and determined incidence rates by procedure . RESULTS Adverse events were no more likely in surgical care than in nonsurgical care . Nonetheless , 66 % of all adverse events were surgical , and the annual incidence among hospitalized patients who underwent an operation or child delivery was 3.0 % ( confidence interval 2.7 % to 3.4 % ) . Among surgical adverse events 54 % ( confidence interval 48.9 % to 58.9 % ) were preventable . We identified 12 common operations with significantly elevated adverse event incidence rates that ranged from 4.4 % for hysterectomy ( confidence interval 2.9 % to 6.8 % ) to 18.9 % for abdominal aortic aneurysm repair ( confidence interval 8.3 % to 37.5 % ) . Eight operations also carried a significantly higher risk of a preventable adverse event : lower extremity bypass graft ( 11.0 % ) , abdominal aortic aneurysm repair ( 8.1 % ) , colon resection ( 5.9 % ) , coronary artery bypass graft/cardiac valve surgery ( 4.7 % ) , transurethral  resection of the prostate or of a bladder tumor ( 3.9 % ) , cholecystectomy ( 3.0 % ) , hysterectomy ( 2.8 % ) , and appendectomy ( 1.5 % ) . Among all surgical adverse events , 5.6 % ( confidence interval 3.7 % to 8.3 % ) result ed in death , accounting for 12.2 % ( confidence interval 6.9 % to 21.4 % ) of all hospital deaths in Utah and Colorado . Technique-related complications , wound infections , and postoperative bleeding produced nearly half of all surgical adverse events . CONCLUSION These findings provide direction for research to identify the causes of surgical adverse events and for targeted quality improvement efforts The main purpose of the present study was to investigate the association between perceived stress and impaired cutaneous wound healing  in humans using a novel wound assessment technique , and taking into account putative mediating factors such as cortisol levels , health behaviours , and personality factors . The study made use of a prospect i ve , within-subjects design in which 24 male non-smokers participated . Every subject received a st and ard 4mm-punch biopsy , and the healing progress was monitored via high-resolution ultrasound scanning . Participants completed question naires on perceived stress , health behaviours , and personality factors , and sample d saliva for  cortisol assessment after awakening at 2 weeks prior , directly after , and 2 weeks after the biopsy . The overall results showed a significant negative correlation between speed of wound healing , and both Perceived Stress scale ( PSS ) scores ( r=-.59 ; p<.01 ) , and General Health Question naire ( GHQ ) scores ( r=-.59 ; p<.01 ) at the time of the biopsy . The area under the morning cortisol response curve was negatively correlated with speed of wound healing ( r=-.55 ; p<.05 ) , indicating a clear elevation in the morning cortisol slope of those whose wounds were slowest to heal . A median split of the complete sample yielded that the ' slow healing ' group showed higher stress levels ( PSS t=3.93 , p<.01 , GHQ t=2.50 , p<.05 ) , lower trait optimism ( t=3.25 , p<.05 ) , and higher cortisol levels to awakening ( F=5.60 , p<.05 ) compared with the ' fast healing ' group . None of the health behaviours investigated ( i.e. alcohol consumption , exercise , healthy eating , and sleep ) were correlated with healing speed at any time point . Our data hint at a considerable influence of stress on wound healing , and suggests that elevated cortisol levels , rather than altered health behaviours , play a role in this effect Background The project aim ed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for cholecystectomy . Methods In two centers for short-stay surgery , patients referred for laparoscopic cholecystectomy were surveyed between Aug 1999 and Jan 2002 . Patients reported on health-related quality of life ( SF-36 ) , symptoms ( gallstone symptom checklist , GSCL ) and other indicators preoperatively ( T0 ) , 14 days ( T1 ) and 6 months postoperatively ( T2 ) . The SF-36 subscales physical functioning , bodily pain , and role physical as well as the GSCL and treatment satisfaction at T2 were considered as main outcomes . The main outcomes were analyzed by generalized linear models with regard to predictors . Results At T0 a total of 205 patients were included . The response rate at T2 was 63.4 % ( 74.6 % females , 53.6 years of age ) . The GSCL score at T0 ( 29.4 % preoperatively ) fell slightly to 27.9 % at T1 and decreased to 14.8 % at T2 ( T0–T2 : p < 0.001 ) . The SF-36 subscales showed a different course over time ( decrease of health-related quality of life at T1 and large increase at T2 ) . The level of satisfaction with the outcome of cholecystectomy was 82.3 % . The patient-reported outcomes were mainly influenced by the preoperative level , age and self-reported postoperative complaints . Conclusion The low response rate was mainly due to nondelivery of question naires at T1 during the regular postoperative visit by the operating physician . Though nonresponse occurs under conditions of routine care , meaningful information was gained , which should be used for quality improvement activities . Because the preoperative level is a major determinant of the postoperative health outcomes , the prospect i ve pre – post measurement should be preferred if institutional comparisons are intended We investigated the impact of perioperative complications on patients ' health-related quality of life ( HRQL ) and intermediate-term survival after cardiac surgery . Improved results for cardiac surgery are well demonstrated in low rates of operative mortality and morbidity . However , the association between perioperative morbid events , HRQL at 1 year , and survival is unclear . We performed a prospect i ve study among 836 elective cardiac surgery patients to assess the impact of perioperative outcomes on survival and HRQL at 1 year . Health-related quality of life  was generated using the 20-item short-form question naire . Kaplan-Meier and life-table estimates were used to examine the relationship of HRQL at 1-year and intermediate-term survival . All HRQL domains were statistically improved at 1 year , with the highest gains in general health perception ( + 19.4 % ) and the least gains in social ( + 5.1 % ) and mental ( + 5.1 % ) domains . Patients experiencing 1 or more perioperative complication or increased length of stay reported similar HRQL scores as patients with no complications . Patients with negative changes in social ( 94.5 % vs 99.2 % , P < .001 ) and general health perception ( 99.4 % vs 95.5 % , P < .001 ) domains showed a reduced survival compared with patients with positive HRQL gains at 2 to 5 years after surgery . Perioperative complications had minimal or no effect on HRQL at 1 year after cardiac surgery Aim To evaluate the effects of Lichtenstein tension-free inguinal hernioplasty on sexual function and generic quality of life , testicular volume , and perfusion . Patients and methods In a prospect i ve study , testicular volume , testicular perfusion , sexual function , generic quality of life , chronic inguinal pain , and groin sepsis were investigated before and 3 and 9 months after  surgical hernia repair .  Results Forty male patients completed this study . No differences in testicular volume or in peak systolic velocity were observed between the hernia and healthy sides of the body ( P > 0.05 ) . Preoperatively , there was a significantly higher end diastolic velocity ( P < 0.04 ) and resistive index ( P < 0.001 ) on the hernia side compared with the normal side ; these elevations returned to normal postoperatively . Three months postoperative , the studied sexual function domains , except orgasm domain , and total sexual score presented significant improvement ( Ps < 0.05 and 0.001 respectively ) . By the end of the study , the mean total sexual score and the number of patients with enhanced total score had showed further clinical progress . The total generic quality -of-life score , general health perception and physical function , vitality , and social domains were statistically recovered at 3 months postoperative ( P < 0.05 ) , with further improvement in total score at 9 months . Two patients developed superficial groin sepsis , and seven ( 17.5 % ) experienced chronic inguinal pain . Conclusion Inguinal hernia impaired testicular perfusion that improved postoperatively . Lichtenstein tension-free hernioplasty improved sexual function and generic quality of life without adverse mesh effects on testicular volume or perfusion Few prospect i ve longitudinal studies have used a vali date d  quality of life ( QOL ) instrument in patients undergoing liver resection for hepatobiliary malignancy OBJECTIVE Perioperative myocardial infa rct ion ( PMI ) is a well-described complication of coronary artery bypass grafting ( CABG ) . Data on its effect on patients ' subsequent health-related quality of life ( QOL ) and on other related consequences is deficient . The aim here was to evaluate in a prospect i ve follow-up design the risk factors for and consequences of PMI and especially its possible impact on health-related QOL . METHODS Comprehensive data , including preoperative risk profile , perioperative variables and postoperative morbidity up to discharge were collected of 501 CABG patients in the Heart Center of Tampere University Hospital and in all eighteen postoperative care hospitals . Eighty patients ( 16 % ) fulfilled ECG or cardiac enzyme criteria for PMI and they were compared to patients with no PMI . The  R AND -36 Health Survey ( R AND -36 ) was used as an indicator of QOL . The primary outcomes were change in physical component summary ( PCS ) , mental component summary ( MCS ) and the eight dimensions of health-related QOL from the R AND -36 . Symptomatic status was estimated according to New York Heart Association ( NYHA ) class . Assessment s were made preoperatively and repeated 12 months later . RESULTS Multivariate logistic regression analysis identified long cardiopulmonary bypass time ( P=0.006 ) and high age ( P=0.049 ) as independent predictors for PMI . Thirty-day mortality was adversely affected by PMI ( 6.3 vs 1.0 % , P=0.001 ) . In discharged patients , the occurrence of PMI did not affect 1-year survival adversely ( 98.7 vs 98.6 % ) . The PMI patients showed significant ( P<0.05 ) improvements in six of the eight dimensions of R AND -36 , but they presented with a negative change in their ' general health ' scores at the follow-up . All QOL scores improved significantly ( P<0.001 ) among the patients without PMI . A highly significant ( P<0.001 ) pattern of change was seen in the R AND -36 PCS and MCS scores in both groups although PMI patients showed significantly ( P=0.002 ) smaller change in their PCS scores . Both groups showed similar freedom from anginal symptoms at 1 year ( 89.6 vs 90.1 % ) but in the PMI group later readmissions due to cardiac-related causes were more common ( 23 vs 10 % , P=0.002 ) . CONCLUSIONS PMI increases 30-day mortality and affects also adversely on later health-related QOL following CABG Purpose The recovery benefits of laparoscopy are traditionally believed to minimize the initial negative impact of surgery on early postoperative quality of life ( QOL ) . We evaluate whether laparoscopic colectomy leads to recovery of QOL early after surgery and evaluate factors associated with the change in QOL . Methods Preoperative and early postoperative QOL data ( SF-36 ) were prospect ively accrued for patients undergoing laparoscopic colorectal resection ( LCR ) ( 2002–2009 ) . Changes in postoperative QOL from preoperative values and effects of patient , disease , operation and postoperative outcomes on these changes were evaluated . Results One hundred and sixty-six patients ( female = 86 ) underwent LCR for cancer ( n = 79 ) , Crohn ’s disease ( n = 24 ) , diverticulitis ( n = 38 ) , and ulcerative colitis ( n = 25 ) with complete SF-36 scores . Median age was 56.9 ( range : 15–91 ) years , mean body mass index 27.4 ± 6.2 kg/m2 with American Society of Anesthesiologists ( ASA ) class being II in 94 patients . Median operative time was 152.5 ( range : 50–358 ) min ; mean length of stay ( LOS ) 4.5 ± 3.3 days . At 4 weeks , the postoperative SF-36 physical component scale ( PCS ) continued to be lower than the preoperative PCS ( 41.8 ± 8.8 vs. 47.1 ± 9.4 , P < 0.001 ) , while the postoperative SF-36 mental component scale ( MCS ) was similar to the preoperative MCS ( 45.6 ± 10.2 vs. 46.1 ± 11.9 , P = 0.17 ) . Gender , age , operation , LOS , surgeon , ASA , BMI , complications , and readmission were not associated with a change in QOL from preoperative values . Cancer as an indication for surgery was associated with less improvement of MCS and PCS ( P = 0.024 and 0.004 , respectively ) . Conclusions Although patients who undergo LCR may have clinical evidence of healing at 4 weeks after surgery , QOL does not return to the preoperative level . This finding may help develop evidence -based recommendations pertaining to timing of return to full activity Introduction : The aim was to analyze the association between selected patient variables and health-related quality of life 6 months after surgery for lung cancer . Methods : In a prospect i ve population -based cohort study , Short Form 36 ( SF-36 ) was used to assess quality of life before and 6 months after surgery for lung cancer . The change in SF-36 summary and subscale scores were used to categorize quality of life in two groups ( worse or stable/improved ) at 6 months compared with baseline . Logistic regression models adjusting for potential confounding factors were used to analyze the association between patient variables and quality of life 6 months after surgery . Results : A baseline SF-36 question naire was completed by 249 patients . Nonresponders at 6 months ( n = 36 ) were excluded , and 14 patients who died before 6 months follow-up remained in the study , leaving 213 patients available for analysis . Gender , comorbidity , occurrence of postoperative complications , and tumor stage were not associated with the physical aspect of quality of life 6 months after surgery . The extent of resection , age , and adjuvant therapy was significantly associated with a clinical ly relevant decline in the SF-36 physical component summary score 6 months postoperatively . No patient variables were predictive of a decline in the mental component summary score . Conclusions : The extent of resection , age , and adjuvant therapy was associated with a clinical ly relevant decline in the physical aspect of health-related quality of life 6 months after surgery . Further studies are needed to explore possible mechanisms To evaluate influence of laparoscopic gastric b and ing ( LGB ) on quality of life ( QOL ) in patients with morbid obesity .  Laparoscopic adjustable gastric b and ing is a popular bariatric operation in Europe . The objectives of surgical therapy in patients with morbid obesity are reduction of body weight , and a positive influence on the obesity-related comorbidity as well the concomitant psychologic and social restrictions of these patients . In a prospect i ve clinical trial , development of the individual patient QOL was analyzed , after LGB in patients with morbid obesity . From October 1999 to January 2001 , 152 patients [ 119 women , 33 men , mean age 38.4 y ( range 24 to 62 ) , mean body mass index 44.3 ( range 38 to 63 ) ] underwent evaluation for LGB  according the following protocol : history of obesity ; concise counseling of patients and relative on nonsurgical treatment alternatives , risk of surgery , psychologic testing , question naire for eating habits , necessity of lifestyle change after surgery ; medical evaluation including endocrinologic and nutritionist work-up , upper GI endoscopy , evaluation of QOL using the Gastro Intestinal Quality of Life Index ( GIQLI ) . Decision for surgery was a multidisciplinay consensus . This group was follow-up at least 2 years , focusing on weight loss and QOL . Mean operative time was 82 minutes ; mean hospital stay was 2.3 days and the mean follow-up period was 34 months . The BMI dropped from 44.3 to 29.6 kg/m2 and all comorbid conditions improved markedly : diabetes melitus resolved in 71 % of the patients , hypertension in 33 % , and sleep apnea in 90 % . However , 26 patients ( 17 % ) had late complications requiring reoperation . Preoperative global GIQLI score was 95 ( range 56 to 140 ) , significant different of the healthy volonteers score ( 120 ) ( 70 to 140 ) P<0.001 . Correlated with weight loss ( percentage loss of overweight and BMI ) , the global score of the group increased to 100 at 3 months , 104 at 6 , 111 at 1 year to reach 119 at 2 years which is no significant different of healthy patients . Analyzing the subscale , physical condition , emotional status , and social integration increased significantly ( P<0.001 ) from preoperative to end of follow-up . Digestive symptoms were not modified . In case of failure of the procedure ( 10.5 % ) global Giqli score is not modified . Patients who have required successfull revisional surgery for late complications ( 6.5 % ) have an excellent QOL outcome that are not different from the whole group . Together with a satisfactory reduction of the excess overweight , laparoscopic gastric b and ing may lead in a carefully selected population of patients with morbid obesity to a significant improvment of patient QOL , in at least 2 years follow-up Background Initial experience with the laparoscopic repair of paraesophageal and type III mixed hiatal hernias showed that it is safe and feasible , with excellent immediate and short-term results . However , after a longer follow-up , a recurrence rate of ≤40 % has been demonstrated . Data related to the outcome of paraesophageal hernia repair and the recurrence rate are still lacking . Quality -of-life scores may offer a better means of assessing the impact of surgical treatment on the overall health status of patients . Therefore , we performed prospect i ve evaluation of anatomic and /or symptomatic recurrences after paraesophageal or large hiatal hernia repair . In addition , we investigated the correlation between recurrence and the patient ’s quality of life . Methods All patients after who had undergone repair of paraesophageal of mixed hiatal hernia were identified prospect ively from a data base consisting of all patients who had had laparoscopic operations for gastroesophageal pathology at our hospital between February 1998 and December 2002 . The preoperative symptoms were taken from patients ’ clinical files . In March 2003 , all patients with ≥6 months of follow-up had a barium swallow and were examined for radiological and clinical signs of recurrence . Thereafter , the patients ’ quality of life after surgery was evaluated using three st and ard question naires ( Short Form 36 [ SF-36 ] , Glasgow Dyspepsia Severity Score [ GDSS ] , and Gastrointestinal Quality of Life Index [ GIQLI ] . Result During the study period , 46 patients had been operated on . The mean age was 63 years ( range , 28–93 ) . Thirty seven of them had a follow-up of ≥6 months . Eight patients ( 21 % ) had postoperative gastrointestinal symptoms . Barium swallow was performed in 30 patients ( 81 % ) and showed a recurrence in six of them ( 20 % ) . According to SF-36 and GDSS , the patients ’ postoperative quality of life reached normal values and did not differ significantly from the st and ard values for the Spanish population of similar age and with similar comorbidities . Successfully operated patients reached a GIQLI value comparable to the st and ard population . However , symptomatic patients had significantly lower GIQLI scores than the asymptomatic or the Rx-recurrent group . Conclusion The laparoscopic treatment of large paraesophageal and mixed hiatal hernias is not only feasible and safe but also offers a good quality of life on a midterm basis . However , the anatomic and functional recurrence rate is high . The next step is to identify the subset of patients who are at risk of failure and to establish technical alternatives that would ensure the durability of the repair BACKGROUND Patients with critical limb ischemia ( CLI ) have multiple comorbidities and limited life spans . The ability of infrainguinal vein bypass to improve quality of life ( QoL ) in patients with CLI has therefore been question ed . Prospect i ve preoperative and postoperative QoL data for patients undergoing lower extremity vein bypass for CLI are presented . METHODS A vali date d , disease-specific QoL question naire ( VascuQoL ) with activity , symptom , pain , emotional , and social domains and responses scored 1 ( lowest QoL ) to 7 ( best QoL ) was administered before surgery and at 3 and 12 months after lower extremity vein bypass for CLI . Changes in QoL at 3 and 12 months after lower extremity vein bypass and multiple predetermined variables potentially influencing QoL after lower extremity vein bypass were analyzed to determine the effect of lower extremity vein bypass on QoL in CLI patients . RESULTS A total of 1404 patients had lower extremity vein bypass for CLI at 83 centers in the United States and Canada as part of the PREVENT III clinical trial . Surveys were completed in 1296 patients at baseline , 862 patients at 3 months , and 732 patients at 12 months . The global QoL score ( mean + /- SD ) was 2.8 + /- 1.1 at baseline and was 4.7 + /- 1.4 and 5.1 + /- 1.4 at 3 and 12 months , respectively . Mean changes from baseline at 3 and 12 months were statistically significant ( P < .0001 ) . Improved QoL scores extended across all domains . Diabetes and the development of graft-related events were associated with decreased improvement in QoL scores , though the mean relative change from baseline remained positive . CONCLUSIONS Patients with CLI have a low QoL at baseline that is improved at 3 and 12 months after lower extremity vein bypass .  QoL improvements are lower in diabetic patients and those who develop graft-related events . Successful revascularization can be expected to improve QoL in patients with CLI , with benefits that are sustained to at least 1 year BACKGROUND The effect of surgery on quality of life ( QOL ) in the early postoperative period is important in Crohn 's disease because of the multiple surgical procedures that patients undergo and the acute QOL benefits that might occur as a result of modifications of medical treatment . Earlier studies of the effect of surgery on QOL have been retrospective and assessed changes 3 to 24 months after surgery . This study prospect ively assesses the effect of surgery on QOL in the early postoperative period . STUDY DESIGN Patients requiring surgical management of sequelae of Crohn 's disease were obtained from a prospect ively entered data base including data on QOL . Preoperative and 30-day postoperative QOL were determined in 82 patients using Clevel and Global Quality of Life ( CGQL ) scores ( range from 0 [ worst ] to 10 [ best possible ] QOL ) . Preoperative and postoperative scores were compared using a paired t-test to determine the significance of any change in QOL after surgery . The effect of other variables on change in QOL after surgery was assessed using the t-test or analysis of variance . Multifactor analysis of variance was used to assess the effect of several independent variables . RESULTS Eighty-two patients ( 41 women ) of 142 patients who had had surgery ( 58 % ) had complete preoperative and 30-day postoperative scores . The incidence of complications was 23 % ( 11 % were major ) . There was a significant improvement in QOL 30 days after surgery as measured by CGQL ( 0.6 + /- 0.2 preoperative to 0.7 + /- 0.2 postoperative ; mean + /- SD ; p < 0.001 ) . The mean preoperative CGQL was 0.56 + /- 0.24 and the mean improvement was 0.11 + /- 0.20 toward a better QOL . Female patients ( p < 0.05 ) and those who did not develop complications within 30 days of surgery ( p < 0.05 ) had a significantly greater improvement in CGQL after surgery than other groups . No other factor was predictive of improved outcomes . CONCLUSIONS QOL as measured by CGQL improves early after surgery ( 30 days postoperatively ) . Improvement in CGQL is greater in female patients and patients who do not develop complications in the postoperative period . It is not affected by other patient characteristics , nature of disease , indication , or procedure performed . Most patients who undergo surgery for Crohn 's disease feel that surgery has helped them and would undergo surgery again Background and objective : Acute renal failure is a serious complication of cardiac surgery . We studied the long‐term survival and quality of life of patients requiring renal replacement therapy after cardiac surgery , since they represent a heavy burden on hospital re sources and their outcome has never been adequately evaluated . Methods : Out of 7846 consecutive cardiac surgical patients , 126 ( 1.6 % ) required postoperative renal replacement therapy :  their preoperative status and hospital course was compared with patients who had no need of postoperative renal replacement therapy . A multivariate analysis identified predictors of renal replacement therapy .  Long‐term survival and quality of life was collected in patients who had renal replacement therapy  and in case‐matched controls . Results : Hospital mortality in the study group was 84/126 ( 66.7 % ) vs. 118/7720 ( 1.5 % ) in the control population ( P < 0.001 ) . Patients who underwent renal replacement therapy and were discharged from the hospital ( 42 patients ) had a reasonable long‐term outcome : at 42 ± 23 months , 30 out of 42 patients were alive , with only 3 patients complaining of limitations in daily activities . Predictors of in‐hospital renal replacement therapy were : emergency surgery , preoperative renal impairment , intra‐aortic balloon pumping , reoperation for bleeding , previous cardiac surgery , female gender , low ejection fraction , bleeding > 1000 mL , chronic obstructive pulmonary disease and age . Conclusions : This study confirms that the in‐hospital mortality of patients requiring renal replacement therapy  is high and shows a low long‐term mortality with reasonable quality of life in patients discharged from hospital alive Background Improved quality of life ( QoL ) is a desirable outcome of cardiac surgery . The aim of the current study was to measure the association between quality of recovery 3 days after surgery and QoL measured 3 months later . Methods After obtaining ethics committee approval and consent , 120 adult cardiac surgical patients were studied . A 40-item quality of recovery score ( QoR-40 ) was used to measure postoperative health status on days 1–3 and 1 month after surgery . QoL was measured using the  short-form health survey ( SF-36 ) at 1 and 3 months after surgery . The effect size ( & Dgr;mean/SD ) was used to define responsiveness , a clinical ly important difference in health . Associations were measured using correlation and reliability coefficients . Results There was a significant change in the mean QoR-40 for up to 1 month after surgery ( P < 0.0005 ) . QoL was improved at 3 months ( P < 0.0005 ) but not 1 month ( P = 0.29 ) after surgery . There was a moderate correlation between day-3 QoR-40 and 3-month SF-36 ( r = 0.39;P < 0.0005 ) . A poor- quality recovery in hospital predicted a poor QoL at 3 months ( adjusted odds ratio , 4.20 ; 95 % confidence interval , 1.41–12.5;P = 0.01 ) . Conclusions The QoR-40 is a valid measure of quality of recovery after surgery and anesthesia . When compared with the SF-36 , it is a better measure of early postoperative recovery . A poor- quality recovery on the days after surgery can predict a poor QoL at 3 months after surgery . This may allow earlier and more effective support strategies while patients are still in the hospital ( counseling , home assistance , local doctor notification , cardiac rehabilitation ) In a retrospective survey , 487 research projects approved by the Central Oxford Research Ethics Committee between 1984 and 1987 , were studied for evidence of publication bias . As of May , 1990 , 285 of the studies had been analysed by the investigators , and 52 % of these had been published . Studies with statistically significant results were more likely to be published than those finding no difference between the study groups ( adjusted odds ratio [ OR ] 2.32 ; 95 % confidence interval [ Cl ] 1.25 - 4.28 ) . Studies with significant results were also more likely to lead to a greater number of publications and presentations and to be published in journals with a high citation impact factor . An increased likelihood of publication was also associated with a high rating by the investigator of the importance of the study results , and with increasing sample size . The tendency towards publication bias was greater with observational and laboratory-based experimental studies ( OR = 3.79 ; 95 % Cl = 1.47 - 9.76 ) than with r and omised clinical trials ( OR = 0.84 ; 95 % Cl = 0.34 - 2.09 ) . We have confirmed the presence of publication bias in a cohort of clinical research studies . These findings suggest that conclusions based only on a review of published data should be interpreted cautiously , especially for observational studies . Improved strategies are needed to identify the results of unpublished as well as published studies BACKGROUND Pain after thoracotomy  is common . The objective of this study was to assess whether pain 3 months postthoracotomy negatively impacts quality of life . METHODS One hundred ten patients were prospect ively assessed using the Medical Outcomes Study  36-Item Short Form Health Survey before and 3 months after elective thoracotomy .  Pain and medication use were evaluated by question naire . Patients experiencing pain at 3 months were compared with patients who did not have postthoracotomy pain . RESULTS Seventy-five patients ( 68 % ) had pain 3 months postthoracotomy ; 12 patients ( 11 % ) rated their average pain greater than 3 ( out of 10 ) . Eighteen ( 16 % ) patients required opioid analgesics . The pain group reported lower SF-36 scores in physical functioning ( p = 0.049 ) , bodily pain ( p = 0.0002 ) , and vitality ( p = 0.044 ) . There were no other significant differences in any SF-36 scale between the pain and non-pain groups . CONCLUSIONS Pain is commonly reported at 3 months after elective thoracotomy but is generally mild , shows improvement with time , and does not usually require opioid analgesics . Patients who experience postthoracotomy pain at 3 months are at risk for significantly decreased physical functioning and vitality , but are not at risk for significantly decreased social , emotional , or mental health functioning compared with patients who do not experience postthoracotomy pain at 3 months Aim The aim of the study was to analyse the incidence of benign colorectal anastomotic stenoses in consecutive patients operated on in a single institution and to assess risk factors for their development . Their impact on quality of life was also evaluated A prospect i ve investigation is described which sought to test the role of illness cognitions in determining patient responses to a  surgical intervention for osteoarthritis .  Illness cognitions were assessed amongst a consecutive sample of patients with osteoarthritis of the knee or hip prior to undergoing joint replacement surgery .  Functional activity and depression were assessed pre-operatively , and at 3 and 9 months post surgery . At pre-operative assessment , functional activity and depression were univariately associated with the perceived consequences of osteoarthritis . Path analyses using longitudinal data demonstrated that illness cognitions had predictive value in explaining outcomes . Depression at 3 months was associated with higher pre-operative perceived control beliefs suggesting that patients who have high control pre-operatively may be at risk for temporary depressed mood in the immediate aftermath of surgery . This effect was not maintained at 9 months . Depression at 9 months was lower amongst patients who were more active at 3 months , who did not attribute their condition to wear and tear and who had higher expectations of surgery . Functional activity at 9 months was higher amongst those who did not attribute their condition to growing older and who perceived more control over symptoms . Socio-demographic variables were not associated with change in functional activity or depression over the course of surgery . The results provide support for an illness cognition approach in explaining functional activity and depression outcomes following surgery
target: Two-thirds of the studies found that patients who suffered surgical complications had significantly worse postoperative psychosocial outcomes even after controlling for preoperative psychosocial outcomes , clinical and demographic factors .
  Surgical complications appear to be a significant and often long-term predictor of patient postoperative psychosocial outcomes .
  The results highlight the importance of attending to patients ' psychological needs in the aftermath of surgical complications
background: OBJECTIVE Surgical complications may affect patients psychologically due to challenges such as prolonged recovery or long-lasting disability .
  Psychological distress could further delay patients ' recovery as stress delays wound healing and compromises immunity .
  This review investigates whether surgical complications adversely affect patients ' postoperative well-being and the duration of this impact .