Postoperative Complications and Health-related Quality of Life 10 Years After Esophageal Cancer Surgery.
Summary (2 min read)
Introduction
- It is estimated 15% of adults worldwide have a disability (Hughes et al, 2012), with Autism Spectrum Disorders (ASD), affecting an estimated 1.1% of the adult population in England (Brugha et al, 2012).
- The understanding of the concept of ‘hate crimes’ and how they are perceived by individuals has meant that there is, as such, no real consensus as to the key characteristics.
- As mentioned earlier the evidence on ASD and hate crime is limited and it is only since 2012, has there been a concentrated interest in autism ‘hate crime’; this is partly in response to legislative pressure as a result of the Autism Act 2009, the first disability specific legislation in the UK.
Bullying
- A survey from the National Autistic Society (2013) reported that more than half of people with ASD including Asperger syndrome they spoke to had been bullied or harassed as adults, and furthermore let down by the criminal justice system.
- Fisher et al (2010) compared adults without disabilities to individuals with ID, who were more likely to experience social victimization, related to money/theft, teasing/persuasion, and abuse.
Victims of sex crimes
- Brown-Lavoie et al. (2014) explicitly explored the risk of sexual victimization in individuals with ASD and what increased that risk.
- They compared ninety-five adults with ASD and 117 adults without ASD through questionnaires regarding sexual knowledge sources, actual knowledge, perceived knowledge, and sexual victimization.
- The increased risk of victimization by individuals with ASD was partially mediated by their actual knowledge.
- Individuals with ASD were between two and three times more likely to experience sexual contact victimization, sexual coercion victimization, and rape than comparison group.
- With the link between knowledge and victimization having important clinical implications for interventions.
Responses to ASD hate crime
- The countries in the UK have their own prosecuting bodies, so procedures may differ.
- The research and campaigning work of charitable organisations such as the National Autistic Society and MENCAP, has greatly helped to bring attention to the issues of hate Crime relating to ASD and ID in the public domain.
- The Independent Police Complaints Commission (IPCC), which investigates police complaints, published its review into the Pilkington case in May 2011.
- Societal change still needs to be worked on.the authors.
Discussion
- Even though progress has been made in the UK there is still a need to create further awareness of what disability hate crime is, its scope and its victims.
- Increasing the reporting of disability hate crime has always been difficult for a number of reasons, such as lack of support, not knowing the process or just through fear.
- The review recommends that together with the Challenge it, Report it, Stop it report (HM Government, 2012) there is sufficient scope given recent progerias to “provide a unique opportunity for the police, CPS and probation trusts to implement changes to policies and procedures.
- This means is that those being targeted and most vulnerable are not able to reach out for adequate support which in turn perpetuates their situation further and threatens both their mental health and general wellbeing and negative impact on their quality of life.
Conclusion
- In summation, the current academic literature is not very clear with regards to how it defines hate crime or victimisation for adults with ASD and ID.
- It is crucial to take in to account the experiences of this vulnerable population, as public policy currently is reflecting that there is a need for further provisions and support for these victims.
- The CJS, police and probation want to tackle this; however, the academic literature is sparse in its understanding of the issues.
- Therefore, it would be useful to map what understanding is present in the current academic literature on adults with ASD and does it reflect the discussion above.
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Cites background from "Postoperative Complications and Hea..."
...also reported on impaired HRQoL after major surgical complications in patients undergoing OTE [58]....
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References
342 citations
"Postoperative Complications and Hea..." refers background in this paper
...Total number 317 (51) 299 (49) 55 (60) 37 (40) Age, median [IQR] 67 (60–73) 68 (60–74) 73 (68–80) 76 (69–81) Sex Male 259 (82) 238 (80) 40 (73) 33 (89) Female 58 (18) 61 (20) 15 (27) 10 (11) Histology Adenocarcinoma 248 (78) 218 (73) 43 (78) 29 (78) Squamous cell 68 (21) 81 (27) 12 (22) 8 (22) Missing 1 (0) 0 (0) Tumor stage I–II 154 (49) 138 (46) 46 (84) 32 (86) III–IV 159 (51) 156 (52) 9 (16) 5 (14) Missing 4 (1) 5 (2) 0 (0) 0 (0) Charlson comorbidity score 0 38 (12) 37 (12) 6 (11) 5 (14) 1 150 (47) 107 (36) 30 (55) 11 (30) 2 129 (41) 155 (52) 19 (35) 21 (57) Annual surgeon volume 0–6 150 (47) 115 (38) 23 (42) 16 (43) 7 167 (53) 184 (62) 32 (58) 21 (57)...
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...and pain), (10) wound infection (symptomatic collection of pus in the wound, requiring treatment), (11) wound rupture (clinically obvious dehiscence, requiring reoperation), (12) bowel obstruction (radiologically verified, demanding surgery), (13) sepsis (which caused clinical symptoms and positive bacterial culture in the blood), (14) pneumonia (which caused clinical symptoms and was radiologically verified), (15) liver insufficiency (progressive or permanent), (16) renal failure (in need of dialysis), (17) deep vein thrombosis (radiologically verified), (18) pulmonary embolism (radiologically verified), (19) myocardial infarction (verified with electrocardiogram or heart enzymes), (20) atrial fibrillation (newly diagnosed by ECG and needing treatment), (21) stroke (radiologically verified), (22) respiratory failure (in need of intubation or mechanical ventilation), and (23) pulmonary edema (newly diagnosed, radiologically verified, symptomatic, and needing treatment)....
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281 citations
"Postoperative Complications and Hea..." refers background or methods in this paper
...Total number 317 (51) 299 (49) 55 (60) 37 (40) Age, median [IQR] 67 (60–73) 68 (60–74) 73 (68–80) 76 (69–81) Sex Male 259 (82) 238 (80) 40 (73) 33 (89) Female 58 (18) 61 (20) 15 (27) 10 (11) Histology Adenocarcinoma 248 (78) 218 (73) 43 (78) 29 (78) Squamous cell 68 (21) 81 (27) 12 (22) 8 (22) Missing 1 (0) 0 (0) Tumor stage I–II 154 (49) 138 (46) 46 (84) 32 (86) III–IV 159 (51) 156 (52) 9 (16) 5 (14) Missing 4 (1) 5 (2) 0 (0) 0 (0) Charlson comorbidity score 0 38 (12) 37 (12) 6 (11) 5 (14) 1 150 (47) 107 (36) 30 (55) 11 (30) 2 129 (41) 155 (52) 19 (35) 21 (57) Annual surgeon volume 0–6 150 (47) 115 (38) 23 (42) 16 (43) 7 167 (53) 184 (62) 32 (58) 21 (57)...
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...The complications were predefined by a group of experienced esophageal cancer surgeons and researchers, and included: (1) major postoperative bleeding (exceeding 2000 mL or requiring reoperation), (2) splenectomy (after failure of other methods of hemostasis), (3) anastomotic insufficiency (clinically and radiologically verified), (4) necrosis of the substitute (clinically significant ischemia with perforation or ulceration), (5) severe lymph leakage (requiring drainage for more than 7 days or reoperation), (6) gastric perforation (postoperatively identified leakage from the gastric tube), (7) esophagotracheal fistula (radiologically and clinically verified, requiring treatment), (8) empyema (radiologically or surgically verified collection of pus at least 3 cm in diameter with symptoms of fever, pain, or dyspnea), (9) intra-abdominal abscess (radiologically or surgically verified collec-...
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...All analyses were adjusted for the following confounding factors: (1) reference HRQOL score for each scale and item at each time point; (2) age in years at each time point (continuous variable); (3) sex: male or female; (4) Charlson comorbidity index: 0, 1, and 2; (5) histology: squamous cell carcinoma or adenocarcinoma; (6) tumor stage: 0 to I or II to IV; and (7) annual surgeon volume: 0 to 6 per year or more than 6 per year....
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...Complications No 317 (51) 55 (60) Yes 299 (49) 37 (40) Type of complication Major bleeding 16 (3) 1 (1) Splenectomy 21 (3) 3 (3) Anastomotic insufficiency 57 (9) 8 (9) Substitute necrosis 6 (1) 0 (0) Severe lymph leakage 13 (2) 0 (0) Gastric perforation 6 (1) 1 (1) Esophagotracheal fistula 11 (11) 1 (1) Empyema 24 (4) 2 (2) Intra-abdominal abscess 9 (1) 1 (1) Wound infection 15 (2) 1 (1) Wound rupture 8 (1) 3 (3) Bowel obstruction 4 (1) 1 (1) Sepsis 54 (9) 8 (9) Pneumonia 74 (12) 9 (10) Liver insufficiency 1 (0) 1 (1) Renal failure 14 (2) 1 (1) Deep vein thrombosis 6 (1) 1 (1) Pulmonary embolism 8 (1) 1 (1) Myocardial infarction 9 (1) 0 (0) Atrial fibrillation 98 (16) 9 (10) Stroke 5 (1) 1 (1) Respiratory failure 101 (16) 13 (14) Pulmonary edema 9 (1) 1 (1)...
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...Each item (on both questionnaires) has a 4-point Likert-scale: (1) ‘‘not at all,’’ (2) ‘‘a little,’’ (3) ‘‘quite a bit,’’ and (4) ‘‘very much,’’ except for the global quality-of-life scale, which has 7 response alternatives ranging from ‘‘very poor’’ to ‘‘excellent....
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174 citations
172 citations
"Postoperative Complications and Hea..." refers background in this paper
...The complications were predefined by a group of experienced esophageal cancer surgeons and researchers, and included: (1) major postoperative bleeding (exceeding 2000 mL or requiring reoperation), (2) splenectomy (after failure of other methods of hemostasis), (3) anastomotic insufficiency (clinically and radiologically verified), (4) necrosis of the substitute (clinically significant ischemia with perforation or ulceration), (5) severe lymph leakage (requiring drainage for more than 7 days or reoperation), (6) gastric perforation (postoperatively identified leakage from the gastric tube), (7) esophagotracheal fistula (radiologically and clinically verified, requiring treatment), (8) empyema (radiologically or surgically verified collection of pus at least 3 cm in diameter with symptoms of fever, pain, or dyspnea), (9) intra-abdominal abscess (radiologically or surgically verified collec-...
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...Complications No 317 (51) 55 (60) Yes 299 (49) 37 (40) Type of complication Major bleeding 16 (3) 1 (1) Splenectomy 21 (3) 3 (3) Anastomotic insufficiency 57 (9) 8 (9) Substitute necrosis 6 (1) 0 (0) Severe lymph leakage 13 (2) 0 (0) Gastric perforation 6 (1) 1 (1) Esophagotracheal fistula 11 (11) 1 (1) Empyema 24 (4) 2 (2) Intra-abdominal abscess 9 (1) 1 (1) Wound infection 15 (2) 1 (1) Wound rupture 8 (1) 3 (3) Bowel obstruction 4 (1) 1 (1) Sepsis 54 (9) 8 (9) Pneumonia 74 (12) 9 (10) Liver insufficiency 1 (0) 1 (1) Renal failure 14 (2) 1 (1) Deep vein thrombosis 6 (1) 1 (1) Pulmonary embolism 8 (1) 1 (1) Myocardial infarction 9 (1) 0 (0) Atrial fibrillation 98 (16) 9 (10) Stroke 5 (1) 1 (1) Respiratory failure 101 (16) 13 (14) Pulmonary edema 9 (1) 1 (1)...
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160 citations
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Frequently Asked Questions (15)
Q1. What contributions have the authors mentioned in the paper "Running head: postoperative complications and hrqol mini-abstract complications were analyzed in relation to 10-year hrqol in a prospective nationwide population-based swedish cohort of 616 patients undergoing open esophageal cancer surgery, hrqol was impaired after complications on twelve of the 25 scales and items measured at 10-year follow-up, including physical function, fatigue, pain, dyspnea, insomnia and eating problems. 3 abstract objective: to evaluate the impact of postoperative complications on health-related quality of life (hrqol) up to 10 years after surgery for esophageal cancer. summary background data: the impact of postoperative complications on hrqol" ?
Kauppila et al. this paper examined the impact of complications on HRQOL at 10 years after esophageal cancer surgery.
Q2. What future works have the authors mentioned in the paper "Running head: postoperative complications and hrqol mini-abstract complications were analyzed in relation to 10-year hrqol in a prospective nationwide population-based swedish cohort of 616 patients undergoing open esophageal cancer surgery, hrqol was impaired after complications on twelve of the 25 scales and items measured at 10-year follow-up, including physical function, fatigue, pain, dyspnea, insomnia and eating problems. 3 abstract objective: to evaluate the impact of postoperative complications on health-related quality of life (hrqol) up to 10 years after surgery for esophageal cancer. summary background data: the impact of postoperative complications on hrqol" ?
Future research may focus on the effect of specific complications on related HRQOL domains in more detail. Therefore, it is important to assess the association between Clavien-Dindo complication severity grading33 and HRQOL in future studies.
Q3. What are the main reasons for the delay in the rehabilitation process?
Postoperative complications prolong the hospital stay and may delay the rehabilitation process, which are important for the patients’ recovery in general.
Q4. How long after surgery did the study examine the effects of postoperative complications?
Exposure was the occurrence of predefined postoperative complications, and the outcome was HRQOL evaluated by validated EORTC questionnaires at 6 months, 3, 5 and 10 years after surgery.
Q5. What is the potential limitation of the study?
Another potential limitation of the study is the change of patients’ perception of HRQOL over time by recalibration of their personal standards, reprioritization of their personal values, and reconceptualization of their quality of life.
Q6. What are the main reasons for poor prognosis?
Major complications during treatment are known to cause deterioration of HRQOL in the short- but also in the long term.9-12 Moreover, complications and poor postoperative HRQOL are known risk factors for poor prognosis.
Q7. How many patients underwent esophageal cancer surgery?
Some 616 patients undergoing open esophageal cancer surgery between April 2, 2001 and December 31, 2005 in Sweden were enrolled in this population-based, nationwide and prospective cohort study.
Q8. How long after surgery is the impact of complications on the health-related quality of life?
To evaluate the impact of postoperative complications on health-related quality of life (HRQOL) up to 10 years after surgery for esophageal cancer.
Q9. How long after surgery did the patients have esophageal cancer?
In this population-based prospective cohort study of patients undergoing open esophageal cancer surgery, postoperative complications were found to be independently associated with poor HRQOL as late as 10 years after surgery.
Q10. How long after surgery did the study show that complications were associated with poor global quality of life?
12 Furthermore, an Italian study showed that postoperative complications were associated with poor global quality of life at 6-12 months.11
Q11. What is the association between complications and poor health outcomes?
Severity of the complications might also be associated with poor HRQOL outcomes in the long-term due to greater inflammatory response and insult to tissue repair caused by for example single- or multi organ failure.
Q12. How was the effect of the long follow-up and newly acquired comorbidities mitigate?
The long follow-up and the newly acquired comorbidities could potentially negatively affect the HRQOL of the patients and bias the results, but this effect was mitigated by adjustment for comorbidity status at the time of follow-up.
Q13. What were the complications of the esophageal cancer surgery?
Complications were analyzed in relation to 10-year HRQOL in a prospective nationwide population-based Swedish cohort of 616 patients undergoing open esophageal cancer surgery, HRQOL was impaired after complications on twelve of the 25 scales and items measured at 10-year follow-up, including physical function, fatigue, pain, dyspnea, insomnia and eating problems.
Q14. How long after surgery do patients with complications have worse quality of life?
The results of the present study show that patients with complications have poorer HRQOL and suffer from more symptoms than those without complications still as long as 10 years after surgery.
Q15. How long after surgery is the occurrence of complications associated with poor HRQOL?
In conclusion, this prospective, population-based cohort study showed that occurrence of postoperative complications is associated with poor HRQOL outcomes up to 10 years after surgery.