Using quality-of-life measurements to predict patient satisfaction outcomes for antireflux surgery.

HYPOTHESIS Preoperative quality-of-life measurement can predict which patients will be satisfied with surgical fundoplication in the treatment of gastroesophageal reflux disease (GERD). DESIGN Review of a prospectively gathered database. SETTING Tertiary referral center. PATIENTS All patients underwent preoperative physiological testing by upper endoscopy, esophageal manometry, and 24-hour esophageal pH monitoring, and some had contrast radiography and gastric emptying scintigraphy. Patients were examined for symptoms and completed a symptom severity questionnaire (the GERD-Health-Related Quality of Life questionnaire) and a generic quality-of-life instrument (the 36-Item Short-Form Health Survey [SF-36]). Patients then underwent either open or laparoscopic fundoplication. MAIN OUTCOME MEASUREMENTS Patients were contacted to assess satisfaction 2 months to 5 years postoperatively. They completed the GERD-Health-Related Quality of Life questionnaire and the SF-36. Patients were grouped into those satisfied and dissatisfied. RESULTS Two hundred ninety patients were included. Median follow-up was 29 months. Thirty-four patients (12%) were dissatisfied with their surgical outcomes for any reason. The dissatisfied patients had statistically significantly worse scores preoperatively in 6 of the 8 domains of the SF-36 than satisfied patients. Dissatisfied patients had less symptomatic improvement. The satisfied patients had statistically significant improvement in 6 domains, whereas the dissatisfied patients had statistically significant worsening of scores in 2 domains. CONCLUSIONS Quality-of-life measurements are frequently used as an outcome end point. This study shows that a generic quality-of-life instrument can preoperatively identify patients with GERD who are likely to be dissatisfied with antireflux surgery. Use of quality-of-life instruments as a predictive tool for surgical outcomes deserves further study.