Defining a Research Agenda for Patient-Reported Outcomes in Surgery

Pezold, Michael; Pusic, Andrea L.; Cohen, Wess A.; Hollenberg, James P.; Butt, Zeeshan; Flum, David R.; Temple, Larissa K.

doi:10.1001/jamasurg.2016.1640

Cited by 47 publications

(33 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally PROMs must be developed in parallel with performance-based measures to enhance the evaluation of both the subjective and objective recovery trajectories. Lastly, as outlined by Pezold et al, there is a need to incorporate PROs within normal clinical practice withintegration into the electronic medical record 55.…”

mentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Abola

Bennett‐Guerrero

Kent

et al. 2018

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.

show abstract

mentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Abola

Bennett‐Guerrero

Kent

et al. 2018

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…Patient-reported outcomes are now viewed by payers and policymakers (including the FDA) as key measures of the effectiveness and quality of care. These agencies recognize that post-operative outcomes, such as symptom severity, functional status, and even satisfaction with aesthetic appearance, can be reliably assessed by the patients themselves 34 .…”

Section: Discussionmentioning

confidence: 99%

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Bennett

Kim

et al. 2017

JAMA Surg

View full text Add to dashboard Cite

Importance Fat grafting has proven to be a useful adjunct to breast reconstruction for the treatment of contour irregularities and volume deficits, but the proposed FDA regulations may severely limit the ability of plastic surgeons to continue its use in this clinical context. Objective To determine if fat grafting has an effect on patient-reported outcomes (PROs) in breast reconstruction patients. Design Longitudinal, multicenter, prospective cohort study conducted between February 2012 and July 2016. Setting Conducted at the 11 study sites associated with the Mastectomy Reconstruction Outcomes Consortium (MROC) study. Participants Eligible patients included women 18 years and older presenting for breast reconstruction following mastectomy with at least two years of follow-up. All primary procedure types (implant- and flap-based) were eligible. Patients were excluded if they had not completed breast mound reconstruction by one year after mastectomy. Interventions Fat grafting as an adjunct to breast reconstruction. Main outcomes and measures Primary end points were patient-reported outcome measures as assessed by the validated BREAST-Q, with higher scores indicating better health-related quality of life. Survey subscales included breast satisfaction, as well as psychosocial, physical, and sexual well-being. Patient-reported outcomes were compared between fat grafted and non-fat grafted patients. Results A total of 2,048 women were included, with 165 undergoing fat grafting between years one and two. One year postoperatively, patients who later underwent fat grafting reported significantly lower breast satisfaction (adjusted mean difference (AMD) = −4.74, CI −8.21 to −1.28, p=0.008), psychosocial well-being (AMD = −3.87, CI −7.33 to −0.40, p=0.029), and sexual well-being (AMD = −5.59, CI −9.70 to −1.47, p=0.008), compared to those who did not receive subsequent fat grafting. Following fat grafting, the fat grafted cohort reported similar breast satisfaction (AMD = −0.68, CI −4.42 to 3.06, p=0.719), psychosocial well-being (AMD = −0.59, CI −3.92 to 2.74, p=0.728), and sexual well-being (AMD = −2.94, CI −7.01 to 1.12, p=0.154) at two years postoperatively. Conclusions and relevance Fat grafting improves breast satisfaction, psychosocial well-being, and sexual well-being in breast reconstruction patients.

show abstract

“…Delphi surveys are increasingly used to foster a consensus among physicians on medical practices and clinical appropriateness [6][7][8][9] . We used a Delphi panel process to achieve a consensus on which steps in 3 common hand surgery procedures are critical.…”

Section: Methodsmentioning

confidence: 99%

The Critical Portions of Carpal Tunnel Release, Ulnar Nerve Transposition, and Open Reduction and Internal Fixation of the Distal Part of the Radius

Antes

Osei

et al. 2018

The Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: Overlapping surgery is attracting increased scrutiny. The American College of Surgeons states that the attending surgeon must be present for all critical portions of a surgical procedure; however, critical portions of surgical procedures are not defined. We hypothesized that a Delphi panel process would measure consensus on critical portions of 3 common hand surgical procedures. Methods: We used a Delphi process to achieve consensus on the critical portions of carpal tunnel release, ulnar nerve transposition, and open reduction and internal fixation of the distal part of the radius. The panelists were 10 hand surgeons (7 fellowship-trained surgeons and 3 fellows). Following an in-person discussion to finalize steps for each procedure, 2 online rounds were completed to rate steps from 1 (not critical) to 9 (extremely critical). We operationalized consensus as ‡80% of ratings within the same range: 1 to 3 (not critical), 4 to 6 (somewhat critical), and 7 to 9 (critical). Because of a lack of consensus on some steps after round 2, another in-person discussion and a third online round were conducted to rate only steps involving disagreement or somewhat critical ratings using a dichotomous scale (critical or not critical). Results: Following the first 2 rounds, there was consensus on 19 of 24 steps (including 3 steps being somewhat critical) and no consensus on 5 of 24 steps. At the end of round 3, there was consensus on all but 2 steps (identification of the medial antebrachial cutaneous nerve in ulnar nerve transposition and clinical assessment of joint stability in open reduction and internal fixation of the distal part of the radius), with moderate disagreement (3 compared with 7) for both. Conclusions: The panel reached consensus on the designation of critical or noncritical for all steps of a carpal tunnel release, all but 1 step of an ulnar nerve transposition, and all but 1 step of open reduction and internal fixation of the continued

show abstract

Defining a Research Agenda for Patient-Reported Outcomes in Surgery

Cited by 47 publications

References 25 publications

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

The Critical Portions of Carpal Tunnel Release, Ulnar Nerve Transposition, and Open Reduction and Internal Fixation of the Distal Part of the Radius

Contact Info

Product

Resources

About