EFFECT OF POSTOPERATIVE COMPLICATIONS ON HEALTH AND EMPLOYMENT FOLLOWING LIVER-TRANSPLANTATION

The influence of postoperative complications on employment and health status following orthotopic liver transplantation (OLT) remains elusiv e. Postoperative complications were scored prospectively using a stand ardized medical outcome classification in each patient transplanted at Duke University from October 1992 to January 1995. Functional status was evaluated by using the Karnofsky score. Between 12 and 18 months f ollowing transplantation, patients were asked to complete mailed quest ionnaires to assess employment and health status (SF-36). The response rate was 86% (42 of 49 eligible patients). The mean patient age was 4 8 yr. Sixteen of 42 patients (38%) exhibited minimal or no postoperati ve complications, and 62% exhibited moderate to severe postoperative c omplications. Age, gender, education, UNOS status for severity of dise ase, insurance status, and Karnofsky score did not correlate with post operative complications. Postoperative complications did not predict e mployment post-transplantation. Paradoxically, patients with minimal o r no postoperative complications perceived that their health status wa s significantly impaired post-transplantation, as evidenced by a media n score of 0 in the role-physical subscale of the SF-36, in contrast t o those patients with moderate or severe postoperative complications w ho exhibited a median score of 25 (p < 0.01). Similarly, patients with minimal or no postoperative complications had significantly lower sco res on the mental health subscale than those with moderate or severe c omplications, with median score of 60 vs. 78 (p < 0.03). The physical functioning subscale was not affected by postoperative complications. Thirteen of 42 (31%) respondents returned to full employment post-tran splantation. Health perceptions differed with respect to employment st atus post-transplantation. Patients unemployed post-transplantation ex hibited a median score of 55 in the physical functioning subscale, a v alue much lower than the median score of 80 in the patients who were e mployed posttransplantation (p < 0.02). No differences in the role phy sical or mental health subscales were noted with respect to employment status posttransplantation. Employment status was unaffected by Karno fsky status, indicating that functional status does not predict employ ment. In conclusion, patients exhibited very poor health perceptions p osttransplantation, irrespective of postoperative complications. Prosp ective evaluation of patients undergoing liver transplantation reveale d that medical complications did not affect employment post-transplant ation.