Patient-reported outcomes after cardiac surgery:Things that really matter

For decades cardiac surgery has been evaluated based on outcomes such as mortality, complications and recurrence of symptoms. Other important outcomes from the patient's perspective, were less considered, but in addition to rapidly improving surgical techniques and the low mortality after surgery, the focus is increasingly shifting to patient-reported outcomes. The studies described in this thesis have been conducted to gain insight into patient-reported outcomes after cardiac surgery, including quality of life, cognitive functioning and return to work.The various studies in this thesis show that undergoing cardiac surgery has a great impact on patient's daily lives. Younger patients often need six months or more to resume work. Physical and emotional complaints are common problems in the process of resuming work, as are the lack of, or conflicting advice given by, the healthcare professionals involved. In addition, the study results show that many patients do not improve in terms of quality of life after cardiac surgery and elderly patients in particular, are more at risk of a deterioration in their postoperative quality of life. To be able to honestly inform patients about what they can expect after surgery, it is important to discuss the preoperative quality of life and the expectations of the patient regarding quality of life before surgery. Especially in frail elderly patients, where a small decline can have important consequences for daily life, it is important to discuss this topic during preoperative shared decision making

The impact of surgical aortic valve replacement on quality of life-a multicenter study:a multicenter study

OBJECTIVES: To explore the effect of surgical aortic valve replacement on quality of life and the variance with age, particularly in patients at risk of deterioration. METHODS: In an observational, multicenter, cohort study of routinely collected health data, patients undergoing and electively operated between January 2011 and January 2015 with pre- and postoperative quality of life data were included. Patients were classified into 3 age groups: 5-point difference as a minimal clinically important difference. Multivariable linear regression analysis, with adjustment for confounders, was used to evaluate the association between age and quality of life. RESULTS: In 899 patients, mean physical health increased from 55 to 66 and mental health from 60 to 66. A minimal clinically important decreased physical health was observed in 12% of patients aged <65 years, 16% of patients aged 65-79 years, and 22% of patients aged ≥80 years (P = .023). A decreased mental health was observed in 15% of patients aged <65 years, 22% of patients aged 65-79 years, and 24% aged ≥80 years (P = .030). Older age and a greater physical and mental score at baseline were associated with a decreased physical and mental quality of life (P < .001). CONCLUSIONS: Patients surviving surgical aortic valve replacement on average improve in physical and mental quality of life; nonetheless, with increasing age patients are at higher risk of experiencing a deterioration

A new tool to assess Clinical Diversity In Meta‐analyses (CDIM) of interventions

Objective: To develop and validate Clinical Diversity In Meta-analyses (CDIM), a new tool for assessing clinical diversity between trials in meta-analyses of interventions. Study design and setting: The development of CDIM was based on consensus work informed by empirical literature and expertise. We drafted the CDIM tool, refined it, and validated CDIM for interrater scale reliability and agreement in three groups. Results: CDIM measures clinical diversity on a scale that includes four domains with 11 items overall: setting (time of conduct/country development status/units type); population (age; sex; patient inclusion criteria/baseline disease severity, comorbidities); interventions (intervention intensity/strength/duration of intervention; timing; control intervention; cointerventions);and outcome (definition of outcome; timing of outcome assessment). The CDIM is completed in two steps: first two authors independently assess clinical diversity in the four domains. Second, after agreeing upon scores of individual items a consensus score is achieved. Interrater scale reliability and agreement ranged from moderate to almost perfect depending on the type of raters. Conclusion: CDIM is the first tool developed for assessing clinical diversity in meta-analyses of interventions. We found CDIM to be a reliable tool for assessing clinical diversity among trials in meta-analysis

External validation of a core outcome set developed in Denmark for the general ICU patient – protocol amendment to an ongoing modified Delphi consensus process

We aim to externally validate a core outcome set for the general ICU patient that is currently under development. This is an amendment to the published protocol (DOI: 10.1111/aas.14024) The amendment is included as an PDF under “Supplemental files…”