PT  - JOURNAL ARTICLE
AU  - Sadaf Mohtashami
AU  - Nadia Safa
AU  - Elena Guadagno
AU  - Robert Baird
AU  - Dan Poenaru
TI  - Derivation of a complication burden score based on disability-adjusted life years to assess patient burden following surgery: a pilot study
AID  - 10.1503/cjs.004819
DP  - 2020 Dec 01
TA  - Canadian Journal of Surgery
PG  - E517--E526
VI  - 63
IP  - 6
4099  - http://canjsurg.ca/content/63/6/E517.short
4100  - http://canjsurg.ca/content/63/6/E517.full
SO  - CAN J SURG2020 Dec 01; 63
AB  - Background: Comparing adverse outcomes following alternative surgical interventions is a complex process for both patients and providers. Disability-adjusted life years (DALYs) are used globally as a quantitative indicator of burden of disease. However, DALYs have not been applied to the burden of postoperative complications. This study explores the feasibility and utility of DALYs in measuring the burden of postoperative complications, using 2 pediatric surgical procedures as a test model.Methods: A literature review was undertaken of postoperative complications following pediatric inguinal hernia repair and intestinal atresia repair. Relevant studies were included, and incidence rates and durations of all key complications were identified. Using existing disability weights of equivalent health states to the complications, we estimated the burden in DALYs of each complication. These estimates were combined into a unitary procedure-specific complication burden score.Results: The key complications contributing to the postoperative burden following inguinal hernia repair were recurrence (0.016 DALYs), hydrocele (0.010), metachronous hernia (0.014) and port-site hernia (0.012). In the case of intestinal atresia repair, death (6.278), reoperation (12.100), stenosis (5.025) and anastomotic stricture (5.327) accounted for most of the postoperative DALYs. The complication burden score was 0.06 DALYs for inguinal hernia and 36.86 for intestinal atresia repair.Conclusion: As a proof of concept, this study supports the feasibility of using DALYs to derive a complication burden score following surgical intervention, and to our knowledge it represents the first application of burden of disease metrics to postoperative adverse outcomes. Future studies should focus on deriving de novo disability weights for common postoperative complications and adverse outcomes.