Patient preferences regarding possible outcomes of lung resection - What outcomes should preoperative evaluations target?

Context: Lung resection can lead to significant postoperative complications : Although many reports describe the likelihood of postoperative problems, such as atelectasis, pneumonia, and prolonged ventilator dependence, it is unclear whether patients perceive these outcomes as sufficiently severe to influence their decisions about surgery. Objective: To assess patients' preferences regarding possible outcomes of l ung resection, including traditional complications reported in the lung sur gery literature and outcomes that describe functional limitation. Design: Utility analysis. Setting: A community hospital internal medicine clinic, a private internal medicine practice, and a private pulmonary practice. Participants: Sixty-four patients, aged 50 to 75 years, who were awaiting a ppointments at the designated clinic sites. Main outcome measure: Patients' strength of preference regarding potential outcomes of lung resection as derived from health utility scores. Results: Common postoperative: complications were assigned high utility sco res by patients. On a scale for which 1.0 represents perfect health and 0 r epresents death, postoperative atelectasis, pneumonia, and 3 days of mechan ical ventilation were all rated >0.75. Scores describing limited physical f unction were strikingly low. Specifically, activity limited to bed to chair movement and the need for complete assistance with activities of daily liv ing were all assigned utility scores <0.2. Twenty-four-hour oxygen dependen ce was scored at 0.33. Presence or absence of pulmonary illness did not pre dict scores for any outcome. Conclusions: Whether patients suffer from chronic lung disease or not, they do not regard the postoperative outcomes reported in the lung surgery lite rature as sufficiently morbid to forego important surgery. However, physica l debility is perceived as extremely undesirable, and anticipation of its o ccurrence could deter surgery. Therefore, identification of preoperative pr edictors of postoperative physical debility would be invaluable for counsel ing patients who face difficult decisions about lung resection.