E196: Exploring the Role of Health-Related Quality of Life in Surgical Decision Making for Pancreatobiliary Patients

ePoster Abstract Author(s)

Naveen Manisundaram, MD MPH

Resident
Baylor College of Medicine, Department of Surgery
HOUSTON, Texas, United States

Submitter(s)

Naveen Manisundaram, MD MPH

Resident
Baylor College of Medicine, Department of Surgery
HOUSTON, Texas, United States

Author(s)

Naveen Manisundaram, MD MPH

Resident
Baylor College of Medicine, Department of Surgery
HOUSTON, Texas, United States
Jorge I. Portuondo, MD

Resident
Baylor College of Medicine, Department of Surgery
Bellaire, Texas, United States
CC

Carolyn Chen, BS

Medical Student
Baylor College of Medicine, Department of Surgery, United States
DE

Derek Erstad, MD

Assistant Professor
Baylor College of Medicine, Department of Surgery, United States
AW

Amy Wood, MPH

Research Manager
Baylor College of Medicine, Department of Surgery, United States
CC

Christy Chai, MD

Associate Professor
Baylor College of Medicine, Department of Surgery, United States
CH

Cary Hsu, MD

Associate Professor
Baylor College of Medicine, Department of Surgery
Houston, TX, United States
ES

Eric Silberfein, MD

Professor
Baylor College of Medicine, Department of Surgery, United States
WF

William Fisher, MD

Professor
Baylor College of Medicine, Department of Surgery, United States
GV

George Van Buren, MD

Associate Professor
Baylor College of Medicine, Department of Surgery, United States
EC

E. Ramsay Camp, MD

Professor
Baylor College of Medicine, Department of Surgery, United States

Introduction:

Pancreatobiliary (PB) disease negatively impacts patients’ health-related quality of life (HRQoL). The influence of baseline HRQoL on peri-operative outcomes is poorly understood. Additionally, there remains debate regarding the success of surgery in improving HRQoL for different PB diseases. This study aimed to investigate the impact of HRQoL on peri-operative outcomes and the effect of surgical resection on HRQoL.

Methods:

PB patients (2011-2016) enrolled in a randomized multicenter trial evaluating intraperitoneal drain usage were evaluated. Secondary post-hoc analysis utilized validated FACT-G survey results and clinical data obtained pre-operatively and 30 days post-operatively. Pre-operative survey responses were aggregated into composite scores and divided into quintiles. Patients in top quintile of HRQoL were compared to patients in the bottom four quintiles combined. Logistic regressions determined associations between quintiles of baseline HRQoL scores and 30-day major complications. Subgroup analysis evaluated change in HRQoL from the difference in pre-operative and 30-day FACT-G scores.

Results:

Of 519 patients evaluated, 152 had Pancreatic/Ampullary Cancer (29.3%), 177 had pancreatic neuroendocrine tumors (34.1%), 149 had cystic lesions (28.7%), 37 had pancreatitis (7.1%), and 4 had other benign disease (0.8%). Baseline HRQoL scores were similar for benign and malignant disease (p=0.44). Patients with HRQoL scores in lower four quintiles in overall FACT-G (OR 1.68, 95% CI 1.02-2.79) as well as physical (OR 2.09, 95% CI 1.13-3.89) and functional domains (OR 2.14, 95% CI 1.25-3.68) had increased likelihood of developing a major post-operative complication (p< 0.001). HRQoL scores were not associated with 30-day mortality (p=0.24). Surgical resection resulted in significant improvement in HRQoL for patients with pancreatitis (10.2 points, p< 0.001) compared to other disease pathologies (-7 to 3.9 points, other diseases) (Figure).

Conclusions:

Among PB patients, baseline HRQoL may serve as supplemental tool for pre-operative risk assessment. Following surgery, HRQoL was significantly improved for patients with pancreatitis but relatively unchanged for patients with malignant disease. Taken together, these findings can inform patients and surgeons about expected patient centered outcomes for major pancreatic surgery and provide a profile of quality of life in association with both a complicated and uncomplicated postoperative course.

Learning Objectives:

Upon completion, participants will be able to describe the impact of baseline health-related quality of life on perioperative complications among pancreatobiliary patients.
Upon completion, participants will be able to describe the impact of surgery on health-related quality of life in patients with different pancreatobiliary disease pathologies.
Upon completion, participant will be able to describe the impact of baseline health-related quality of life on perioperative mortality amongst pancreatobiliary patients.