Recovery of Patient-Reported Quality of Life After Esophagectomy.

BACKGROUND: Esophagectomy is an important, but potentially morbid, operation used to treat benign and malignant conditions that may significantly impact patient quality of life(QOL). Patient-reported outcomes(PRO) are measures of QOL that come directly from patient self-report. This study characterizes patterns of change and recovery in PRO in the first year after esophagectomy.

METHODS: Longitudinal QOL scores measuring physical function, pain, and dyspnea were obtained from esophagectomy patients during all clinic visits. PRO scores were obtained using NIH-sponsored PROMIS(Patient-Reported Outcomes Measurement Information System) from April 2018-February 2021. Mean PRO scores over 100 days after surgery were compared with baseline PRO scores using mixed effects modeling with compound symmetry correlational structure.

RESULTS: A total of 103 patients with PRO results were identified. Reasons for esophagectomy included malignancy (87.4%), achalasia (5.8%), stricture (5.8%), and dysplasia (1.0%). When comparing mean PRO scores at visits≤50 days post-surgery to preoperative PRO scores, physical function scores declined by 27.3% (p<0.001), while dyspnea severity and pain interference scores had increased respectively by 24.5% (p<0.001) and 17.1% (p<0.001). While recovery occurred over the course of the 100 days post-surgery, mean physical function scores and dyspnea scores were still respectively 12.7% (p=0.02) and 26.4% (p=0.001) worse than mean preoperative levels.

CONCLUSIONS: Despite declines in QOL scores immediately after esophagectomy, recovery back towards baseline is observed during the first 100 days. These findings are of considerable importance when counseling patients regarding esophagectomy, tracking recovery and implementing quality improvement initiatives. Further long-term follow-up is needed to determine recovery beyond 100 days.