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Patient‐reported complications are increasingly being used to compare the performance of surgical departments. Dr Grosse and colleagues from the United Kingdom explored the validity of patient‐reported complications, and determined their influence on patients' reports of the benefits of surgery (health gain). The researchers performed an observational study of patients in England who underwent hip replacement, knee replacement, inguinal hernia repair or varicose vein surgery during 2009–2011. Health gain was assessed with condition‐specific measures of symptoms and disability, health‐related quality of life (EQ‐5D™ index), and a single item on the success of surgery. Adverse outcomes included 4 complications, readmission and further surgery.  | | Complications were strongly associated with readmission and further surgery | | British Journal of Surgery |
The research team found evidence that patient‐reported complications were valid. The researchers noted that patients with 3 or more co‐morbid conditions reported more complications, whereas age, sex and socioeconomic status had little, or no association. The team found that complications were strongly associated with readmission and further surgery. Among patients reporting a complication, the Oxford Hip Score or Oxford Knee Score was about 3 points lower than the value in patients not reporting a complication. The EQ‐5D™ score was about 0.07 lower for joint replacement, 0.06 lower for hernia repair, and 0.04 lower for varicose vein surgery. Dr Grosse's team concludes, "Patients' reports of complications can be used for statistical comparisons of surgical departments." "If the relationship between complications and health gain is causal, there is scope for improving health gain indicators after surgery by minimizing the risk of a complication."
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