Objective:The aim of our study was to explore long-term health-related quality of life (HRQOL) and incidence of post-traumatic stress disorder (PTSD) in extracorporeal membrane oxygenation (ECMO) s...

Long-term quality of life in patients treated with extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock.

Thank you for your insightful comments regarding the interpretation of the statistical tests in your Letter to the Editor. We acknowledge that the positive and negative predictive values are influenced by the prevalence of the disease. It is important to point out that although we reported positive and negative predictive values, we have reported and discussed all measures of diagnostic accuracy for the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. This includes measures that are independent of disease prevalence, including sensitivity, specificity, likelihood ratios and the area under receiver operating characteristic (AUROC) curve. Our study showed that the LRINEC test has reasonable sensitivity, high specificity and an excellent AUROC curve, demonstrating good diagnostic accuracy. It is useful to take into account all these measures of diagnostic accuracy while utilizing the LRINEC score. The main take-home message we wish to emphasize from this study is that while the LRINEC test is a useful, easy test to perform with good diagnostic accuracy, it does not supersede clinical examination and maintaining a high clinical suspicion for the disease remains the gold standard for diagnosing necrotizing fasciitis.

Response to Re: Laboratory Risk Indicator for Necrotizing Fasciitis score for early diagnosis of necrotizing fasciitis in Darwin.

Abstract Background Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients’ perspective. Aims To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted. Methods Electronic databases (including MEDLINE, CINAHL, Embase) were searched between January 2001 and December 2020 for studies determining predictors of HRQoL (using a recognised and validated tool) in adult patients undergoing cardiac surgery. Data extraction and quality assessments were undertaken and data was summarised using descriptive statistics and narrative synthesis, as appropriate. Results Overall, 3924 papers were screened with 41 papers included in the review. Considerable methodological heterogeneity between studies was observed. Most were single-centre (75.6%) prospective observational studies (73.2%) conducted in patients undergoing coronary artery bypass graft (CABG) (n = 51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent predictors (62 pre-operative, five intra-operative and 36 post-operative) were identified, where 34 (33.0%) were reported in more than one study. Potential pre-operative modifiable predictors include alcohol use, BMI/weight, depression, pre-operative quality of life and smoking while in the post-operative period pain and strategies to reduce post-operative complications and intensive care and hospital length of stay are potential therapeutic targets. Conclusion Despite a lack of consistency across studies, several potentially modifiable predictors were identified that could be targeted in interventions to improve patient or treatment outcomes. This may contribute to delivering more person-centred care involving shared decision-making to improve patient HRQoL after cardiac surgery. 

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Predictors of health-related quality of life after cardiac surgery: a systematic review

BACKGROUND The study aimed to evaluate the long-term change of health-related quality of life (HRQOL) and to identify predictors of HRQOL 5 years after cardiac surgery. METHODS Consecutive adult patients, undergoing elective cardiac surgery were enrolled in the study. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire before and 5-years after cardiac surgery. A multivariate latent change modeling approach was used for data analysis. RESULTS 210 participants (30.5% female) were reached at 5-year follow-up and included in final data analysis. The study revealed, after controlling for gender effects, a significant long-term positive change, in physical functioning (PF, Mslope = 19.79, p < 0.001), social functioning (SF, Mslope = 17.27, p < 0.001), vitality (VT, Mslope = 6.309, p < 0.001) and mental health (MH, Mslope = 8.40, p < .001) in the total sample. Lower education was associated with an increase in PF (Mslope = 24.09, p < 0.001) and VT (Mslope = 8.39, p < 0.001), more complicated surgery (other than the coronary artery bypass graft (CABG) predicted increase in general health (GH, Mslope = 6.76, p = 0.005). Arrhythmia was a significant predictor for lower pre- and post-operative VT and SF. CONCLUSIONS Overall HRQOL in our sample improved from baseline to five years postoperatively. Further studies including larger patient groups are needed to confirm these findings.

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Predictors of long-term HRQOL following cardiac surgery: a 5-year follow-up study.

Perfusion variables in the 2010 update of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

BACKGROUND Long-term improvement in health-related quality of life (HRQOL) is one of the most important outcomes of cardiac surgery. The aim of this study is to define the impact of perioperative patient and procedural variables on HRQOL dynamics, a year after cardiac surgery. METHODS Consecutive patients undergoing elective on-pump cardiac surgery were enrolled in this prospective observational cohort study. Patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire a day before surgery and once again a year after surgery. The effect size method was used to determine whether treatment resulted in the improvement of HRQOL. RESULTS A total of 67.3% of patients achieved long-term improvement in HRQOL. Significant negative association was identified between Physical and Mental Component Summary scores (PCS/MCS) and long-term outcomes. Pre-operative PCS were 40.7 ± 13.7 for improvers and 56.6 ± 14.4 for non-improvers; MCS were 45.8 ± 12.1 and 65.2 ± 13.7, respectively (P < 0.001 for all). There were no statistically significant differences in pre-operative risk factors, demographics, operative factors or post-operative variables between the two groups. CONCLUSION Among those completing this study, one in three patients did not experience long-term HRQOL improvements following cardiac surgery. Multivariate analysis confirmed that higher pre-operative PCS and MCS are independent predictors of worse HRQOL a year after surgery. Further research should focus on establishing the prevalence of this phenomenon worldwide and develop targeted interventions to improve long-term self-perceived quality of life for patients with relatively good pre-operative health.

Indre Urbanaviciute

Papers

Impact of pre-operative health-related quality of life on outcomes after heart surgery.