Disability-free survival after surgery

Anaesthetists at The Alfred have applied an internationally recognised disability measure – previously reserved for arthritis, stroke and other patient groups – to track the wellbeing of patients up to one year after undergoing surgery.The tool is a questionnaire developed by the World Health Organisation (WHO), which has not previously been applied to the measure of outcomes after surgery.

Perioperative research has traditionally focused on surrogate outcomes such as length of hospital stay, or clinician focused outcomes such as myocardial infarction, stroke, and other major medical complications. These outcomes occur with varying severity and are of variable significance to patients.

More recently, patient-centred outcome measures have been used to assess perioperative outcomes that are important to the patient. Survival and freedom from new or worsened disability after surgery are important outcomes. Until now, no measure of disability has been validated in a surgical population.

The team evaluated the psychometric properties of the WHO Disability Assessment Schedule 2.0 (WHODAS) in a diverse cohort of 510 patients up to 12 months after surgery. They found that WHODAS was clinically acceptable, valid, reliable and responsive in this surgical population. In addition, when combined with survival, WHODAS can be used to measure disability-free survival, providing an outcome measure for future perioperative research and clinical audit that is meaningful to clinicians and patients alike.