Observational Research on Quality of Life Before and After Major Surgery: Insights from a Developing Country

INTRODUCTION: Changes in health-related quality of life (HRQoL) both before and several days after surgery, which may better reflect patients' health status and help in providing more efficient perioperative care, have rarely been investigated. Therefore, we sought to assess patients' HRQoL before undergoing major elective surgeries at admission (baseline) and at 6 weeks after surgery (follow-up). METHODS: A prospective cohort study was conducted from October 2021 to March 2022 using the EuroQol-5D (EQ-5D) instrument with a utility score (EQsum) and a visual analog scale (EQ-VAS) for the assessment of HRQOL. Two hundred and ten patients were scheduled for elective major surgery (hepatobiliary, spine and orthopedic, abdominal hernia, lower and upper GI, breast and endocrine). at An-Najah National University Hospital (NNUH) and Rafidia Surgical Hospital (RSH) were enrolled. RESULTS: The study included 210 participants, with 126 female (60%) and 84 (40%) male patients. The average age of the subjects was 49 ± 5 years. Approximately 40% of participants were classified as overweight, while approximately two-thirds had completed high school and were unemployed. Additionally, 41% of participants reported having a low income, defined as less than 1750 Shekels. The study showed a statistically significant difference in patients' EQsum scores before and after major surgical interventions. The different components of the EQ-5D were mobility (p < 0.001), self-care (p < 0.002), daily activities (p < 0.001), pain/discomfort (p < 0.001), and depression/anxiety (p < 0.001). Patients reported improved overall health on the EQ-VAS after surgery (p <0.001). The EQsum scores were greater in the postoperative period, specifically for younger individuals, individuals with higher educational levels, individuals with higher income levels, and smokers. CONCLUSION: This study revealed a noticeable difference in HRQoL between the preoperative period and the postoperative period; therefore, the null hypothesis was rejected for all quality-of-life components: mobility, self-care, activities, anxiety and pain. The majority of patients reported having the same HRQoL in both periods, with more than one-third reporting an improvement in the postoperative period. Healthcare providers should be aware of low HRQoL among patients with no formal education, smokers, elderly individuals, and low income to improve their HRQoL.