Weighing the costs and benefits of surgery

If you knew that your recovery from surgery would last months or even years, would that change your mind about having it?

Hamilton Health Sciences researchers at the Population Health Research Institute (PHRI) are looking to shed some light on that question and hopefully make the decision making-process easier for patients.

At the root of this work is functional ability, which includes basic actions like bathing and eating, and how these everyday tasks relate to quality of life. Studies have shown that many adult patients requiring health care would rather live a fulfilling life than a longer one.

According to Dr. Jessica Spence, a medical resident and PhD candidate whose thesis is investigating this topic, there’s a significant knowledge gap when it comes to functional outcomes following elective surgeries.

“This study is the first step in establishing a means to improve patient decision-making regarding whether or not surgery is the right choice for them.”

“We’re very good at determining a patient’s chance of surviving a procedure, but we don’t know a lot about day-to-day living after the fact,” she says. “We’re essentially looking to develop a risk-benefit framework so patients know what to expect. Currently, this doesn’t exist.”

The main reason why so little is known about functional outcomes is that no one has developed a way to test it. But that may be about to change. “This study is the first step in establishing a means to improve patient decision-making regarding whether or not surgery is the right choice for them. Our work is looking to lay the foundational pieces to help this emerging field of study,” says Dr. Spence.

Focusing on patients who recently had heart surgery, researchers are looking at this through global and local lenses. Using patient data collected through another study involving 15,000 patients across 12 countries, the team is running this information through an internationally recognized tool developed at PHRI called the SAGE scale, which was created to assess activity in elderly patients. Data are being collected at 30-days after surgery and then again at the one-year mark to determine progression in patient function over a 365 day period.

“I want to empower patients to make informed decisions about their health and their health care.”

Dr. Spence is contrasting this work with hands-on research in the Hamilton area by supervising a team of occupational therapy students from McMaster University who visit and observe patients who have also recently undergone heart surgery. Using the same 30 day and one-year timeframe, the goal is to determine if the SAGE scale can produce the same results as in-person assessments. Results of this study should be available within a year.

“I want to empower patients to make informed decisions about their health and their health care,” Dr. Spence says. “Surgery is significant and recovery can be difficult. Patients need to know that they may not be able to return to work or play with their grandkids for a long time. The only way we can do that is find a way to tell them what they can expect if they choose to have surgery.”