Perioperative Patient-Reported Outcomes Predict Serious Postoperative Complications: a Secondary Analysis of the COST Trial

Decreased survival after colon cancer surgery has been reported in patients with deficient preoperative quality of life. We hypothesized that deficits in preoperative quality of life are associated with postoperative complications.

A secondary analysis of the Clinical Outcomes Surgical Therapy trial NCCTG 93-46-53 (INT 0146, Alliance) was performed. Quality of life deficit was defined as overall quality of life score <50 on a 100-point scale and used for univariate and multivariate analysis.

Of 431 patients enrolled in the quality of life portion of the trial, 81 patients (19 %) experienced complications including two deaths (0.5 %). Fifty-five patients (13 %) had a preoperative quality of life score <50. Patients with a preoperative deficit were more likely to have a serious early complication (16 vs 6 %, p = 0.023). Using stepwise logistic model, the variables significantly associated with having any early complications (yes/no) were age, ASA III and change in “activity” from baseline to day 14. Patients with an early complication experienced a 3.5-day longer hospital stay (p = 0.0001). Gender, race, tumor stage, and laparoscopic or open approach were not associated with an increased frequency of complications. After adjusting for demographics, tumor stage, ASA, and operative approach, significant predictors for readmission were preoperative pain (odds ratio (OR) 1.61, confidence interval (CI) 1.11–2.34, p = 0.0125), and changes from baseline to day 2 in fatigue (OR 1.34, CI 1.03–1.74, p = 0.032).

This study suggests that quality of life can provide an early indicator for patients at risk of complications. Further studies should evaluate how perioperative quality of life assessment may assist to improve outcomes.