Effect of Post-Operative Complications on Patient Satisfaction: Results from a Cohort of 200 Breast Reconstruction Patients using Breast-Q© and RAND-36
Ricardo J. Bello, MD, MPH, Melanie R. Major, BS, Chris Devulapalli, MD, Anil Kashyap, MD, DDS, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.
Purpose: Despite advances in surgical techniques and quality improvement, considerable numbers of breast reconstruction patients still experience post-operative complications. This study investigated the effect of post-operative complications on breast-specific and general quality-of-life in patients who underwent breast reconstruction.
Methods: We analyzed prospectively-collected patient-reported quality of life measurements on all patients undergoing breast reconstruction at our institution between November 2010 and June 2013. Breast-Q© and RAND-36 scores were available preoperatively, after tissue expander placement, and 6 and 12 months after final reconstruction. We used t-tests and rank-sum tests to assess the effect of post-operative complications on patient satisfaction and quality-of-life.
Results: Of 200 patients completing long-term follow-up, 32 (16%) experienced post-operative complications. Patients with complications had significantly decreased Breast-Q© scores for Satisfaction with Information (12.74 points; 95%CI:1.34-24.14; p=0.029) and Satisfaction with Outcome (17.90 points; 95%CI:4.12-31.68; p=0.012). These differences were also clinically relevant. We found suggestive evidence for a decrease in Satisfaction with Surgeon (p=0.053) and Satisfaction with Office Staff (p=0.050) and no evidence for a difference in RAND-36 Physical (p=0.442) and Mental (p=0.281) Summary Scores.
Conclusions: These findings highlight the negative effects of post-operative complications on patient satisfaction, which go beyond well-characterized clinical outcomes and economic concerns. In particularly, our results imply the importance of patient safety interventions and educating patients pre-operatively to mitigate lower satisfaction and QOL scores.
|Domain/Scale||All||No complications||Complications||Differences (95% CI)||p-value|
|Satisfaction with Breasts||9.21±29.73||8.97±28.92||10.44±34.17||-1.47 (-12.81 - 9.88)||0.799|
|Satisfaction with Information||2.92±20.40||4.60±19.52||-8.14±23.34||12.74 (1.34 - 24.14)||0.029|
|Satisfaction with Outcome||-0.08±22.28||1.99±19.54||-15.91±34.45||17.90 (4.12 - 31.68)||0.012|
|Satisfaction with Surgeon||-0.72±16.47||0.49±14.87||-8.64±23.76||9.13 (-0.11 - 18.38)||0.053|
|Satisfaction with Medical Staff||-2.47±16.80||-1.24±13.55||-10.21±29.97||8.98 (-0.49 - 18.45)||0.242|
|Satisfaction with Office Staff||-1.7±19.13||-0.26±17.40||-11.0±26.84||10.84 (-0.01 - 21.50)||0.050|
|Physical Health summary score||1.75 ± 19.19||2.24 ± 17.72||-0.68 ± 25.56||2.91 (-4.54 to 10.37)||0.442|
|Mental Health summary score||5.33 ± 18.86||6.01 ± 17.93||1.99 ± 22.93||4.02 (-3.31 to 11.35)||0.281|
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