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Validation of the SF-36 as a measure of postoperative recovery after colorectal surgery

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Abstract

Introduction

Surgery is evolving, and new techniques are introduced to improve “recovery.” Postoperative recovery is complex, and evaluating the effectiveness of surgical innovations requires assessment of patient-reported outcomes. The Short-Form-36 (SF-36), a generic health-related quality of life questionnaire, is the most commonly used instrument in this context. The objective of this study was to contribute evidence for the validity of the SF-36 as a metric of postoperative recovery.

Methods

Data from 128 patients undergoing planned colorectal surgery at one university hospital between 2005 and 2010 were analyzed. In the absence of a gold standard, the responsiveness and construct validity (known groups and convergent) of the SF-36 were evaluated. Standardized response means were computed for the former and non-parametric tests were used to assess the statistical significance of the changes observed. Multiple linear regression was used to determine whether the SF-36 discriminates between patients with versus without complications and between laparoscopic and open surgery (known groups); correlations between the SF-36 and the 6-min walk test, a measure of functional walking capacity (convergent) was investigated with Spearman’s rank correlation.

Results

The SF-36 was sensitive to clinically important changes. Scores on six of eight domains and the physical component summary score deteriorated postoperatively (SRM 0.86 for the PCS, p < 0.01) and improved to baseline thereafter. Patients with complications had significantly lower scores on five SF-36 domains (with differences from −9 (−18, −1), p = 0.04 to −18 (−32, −2), p = 0.03), and scores on all subscales were lower than those in a healthy population (p < 0.01 to p = 0.04). The SF-36 did not differentiate between laparoscopic and open surgery. Physical functioning scores correlated with 6MWT distance at 1 and 2 months (Spearman’s r = 0.31 and 0.36, p < 0.01).

Conclusions

The SF-36 is responsive to expected physiological changes in the postoperative period, demonstrates construct validity, and thus constitutes a valid measure of postoperative recovery after planned colorectal surgery. The SF-36 did not, however, discriminate between recovery after laparoscopic and open surgery.

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Acknowledgments

Dr. IA is supported by a scholarship from the Quebec Research Fund for Health Sciences (FRSQ), and the McGill Surgeon Scientist Program. The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation is supported by an unrestricted educational grant from Covidien Canada. Dr. LSF is a paid consultant for Covidien and is the recipient of an investigator-initiated research grant from Ethicon and an unrestricted educational grant from ConMed.

Disclosures

Dr. IA is supported by a scholarship from the Quebec Research Fund for Health Sciences (FRSQ) and the McGill Surgeon Scientist Program, but has no conflicts of interest or financial ties to disclose. Dr. FC and Dr. NEM have no conflicts of interests or financial ties to disclose. Dr. LSF is a paid consultant for Covidien and is the recipient of an investigator-initiated research grant from Ethicon and an unrestricted educational grant from ConMed. The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation is supported by an unrestricted educational grant from Covidien Canada.

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Authors and Affiliations

  1. Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9.300, Montreal, QC, H3G 1A4, Canada

    Ioana Antonescu & Liane S. Feldman

  2. Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada

    Francesco Carli

  3. Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada

    Nancy E. Mayo

Authors
  1. Ioana Antonescu
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  2. Francesco Carli
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  3. Nancy E. Mayo
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  4. Liane S. Feldman
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Corresponding author

Correspondence to Liane S. Feldman.

Additional information

Presented as a poster at SAGES April 2014, Salt Lake City (Utah).

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Antonescu, I., Carli, F., Mayo, N.E. et al. Validation of the SF-36 as a measure of postoperative recovery after colorectal surgery. Surg Endosc 28, 3168–3178 (2014). https://doi.org/10.1007/s00464-014-3577-8

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  • DOI: https://doi.org/10.1007/s00464-014-3577-8

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