Quality-of-life assessment: recent trends in surgery

A literature review conducted for a 1989 article on assessing the quality of life in surgical studies revealed that quality of life was more often mentioned than measured. Few authors reported the use of known, standardized scales. The objective of this study was to determine if and to what extent this situation has changed. A MEDLINE search of surgical studies published between 1989 and 1995 produced over 277 abstracts of surgical studies containing the words "quality of life." The abstracts were studied in three time periods: 1989-1990, 1991-1992 and 1993-1995. Findings indicated that the use of the term "quality of life" increased markedly over the study period, and studies using standardized measures escalated from 27.4% in 1989-1990 to 48.3% in 1993-1995. Those abstracts not stating how quality of life was assessed decreased from 48.4% in the early period to 21.7% in the last period. Of the abstracts reporting studies that used quality of life measures, 33% came from cancer studies, 21.7% from cardiovascular or respiratory studies, 14.8% from gastroenterology studies, 13.4% from nephrology studies and 6.1% from orthopedic studies. Surgical investigators selected a variety of global measures of quality of life as well as disease-specific instruments. The abstracts also revealed that surgeons are using quality-of-life assessment to monitor patients over time, to help select patients for surgery, to determine the effect of surgical treatment and for making policy decisions. Notwithstanding the limitations of this project, there is evidence in the literature that surgeons are increasingly willing to assess the impact of the surgical interventions by quality-of-life measures and are becoming more familiar with the diverse measures used to assess quality of life.