Relationship between patients’ reports of complications and symptoms, disability and quality of life after surgery

Background: Patient reported post-operative complications are increasingly being used to compare the performance of surgical providers. Our objectives were to explore the construct validity of patient reported complications and determine their influence on patients’ reports of the benefits of surgery (health gain).

Method: Observational study of patients in England who underwent hip replacement (68 391), knee replacement (77 705), inguinal hernia repair (48 199) or varicose vein surgery (16 535) during 2009–11. Health gain was assessed with Oxford Hip Score, Oxford Knee Score, Aberdeen Varicose Vein Questionnaire and the EQ–5D (health related quality of life).

Results: There was evidence of the construct validity of patient-reported complications: three or more comorbid conditions was associated with a higher rate of complications whereas age, sex and socio-economic status had little or no association; complications were strongly associated with readmission and further surgery. An adverse outcome was associated with less health gain: for joint replacements, a complication was associated with the OHS or OKS score being about 3 points lower and those readmitted were up to 8 points lower; a complication was associated with the EQ–5D score being 0.07 lower for joint replacements, 0.06 lower for hernia repair and 0.04 lower for varicose vein surgery.

Conclusion: Patients’ reports of complications can be used for statistical comparisons of providers. If the relationship between complications and health gain is causal, there is scope for providers to improve their health gain indicators by minimizing the risk of a complication.

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Patient reported outcomes