PATIENT RECOVERY AFTER MAJOR GASTROINTESTINAL SURGERY: IS THERE A DIFFERENCE BETWEEN MINIMALLY INVASIVE AND OPEN APPROACHES?

Cornelius A Thiels, DO, MBA, Kristine T Hanson, MPH, Kellie L Mathis, MD, Paul J Novotny, MS, Mark J Truty, MD, MS, Jeff A Sloan, PhD, Juliane Bingener, MD. Mayo Clinic

Objectives: Patients define recovery from surgery as return to normal function; however, little data exist about return to normal after major gastrointestinal surgery. We compared recovery after MIS and open GI surgery using NIH endorsed Patient Reported Outcomes (PRO) tools.

Methods: Patients scheduled for open or MIS GI surgery (pancreaticoduodenectomy, esophagectomy, colectomy, and proctectomy) were enrolled in a prospective study. Demographics, complications, and PRO were collected using validated PROMIS and LASA scales pre-operatively, post-operative day (POD) 2, 7, 14, 30, and monthly until 6 months post-op. Patients were asked if they had fully recovered. Comparison between approaches was performed in a treatment-received analysis using Area Under the Curve (AUC) and multivariable mixed-effects repeated measures models controlling for covariates. Return to baseline was defined as PRO scores within ½ SD of baseline. Initial 30-day outcomes are reported here.

Results: Of 340 enrolled patients (median age 60 years, 44% women), 158 underwent open and 182 MIS procedures, including 125 pancreaticoduodenectomies, 20 esophagectomies, 153 colectomies, and 42 proctectomies. Mortality was 0.9% and 19% had grade ≥III complication. Patients undergoing open surgery tended to be older, had greater ASA scores, and were more likely to have cancer (all p<0.05 vs. MIS). All patients experienced significant decline by POD 2; PRO scores were significantly better in MIS patients throughout the 30 post-operative days (Figure). PROMIS Physical T and LASA QOL scores returned to baseline in 42% and 54% of patients at 30-days, respectively (PROMIS Physical T score: 52% MIS vs 31% open, p<0.001; LASA QOL: 62% MIS vs 44% open, p=0.001). At 30 days 20% of all patients reported feeling recovered (14% open vs 25% MIS, p=0.02). On multivariable analysis, improvement in PRO scores over time varied by approach, where MIS was associated with a slightly higher PROMIS Physical T score at each time point (estimate 1.75 higher, p=0.002 vs open at 30 days) and LASA QOL score at each time point (estimate 0.56 higher, p=0.03 vs open at 30 days).

Conclusion: All patients had a significant drop in PRO measures immediately after surgery with about half returning to baseline by 30 days. Only 1/5 patients felt recovered. QOL was slightly better at 30 days in MIS patients compared to open surgery; longer follow-up may better delineate patient recovery.