22 The impact of surgical site infection on patient reported outcomes following surgery for intestinal failure

Aim Surgical site infection (SSI) affects more than half of patients undergoing surgery for intestinal failure (IF) and can have a profound and debilitating impact on recovery after surgery. Research into SSI following gastrointestinal surgery has focused predominantly on clinical outcomes, with the impact of SSI on health-related quality of life (QoL) following IF surgery yet to be described. Risk of infective complications may predispose IF surgical patients to increased decisional conflict and decision regret. Patient reported outcome measures (PROMs) can offer clinicians a greater understanding of patients’ preferences, needs and the effect of disease and treatment on their daily lives. We sought to investigate the impact of IF surgery and SSI on a range of validated patient reported outcomes across the perioperative period. Methods Adult patients undergoing elective surgery at a single quaternary referral centre with a diagnosis of IF or enterocutaneous fistula (ECF) were enrolled in a prospective, observational, cohort study between January and October 2022. ECF patients completed the wound specific QoL tool (WoundQoL) at baseline. All patients completed a generic QoL questionnaire (EQ-5D-5L) and Decision conflict scale (DCS) preoperatively; and Wound-QoL, EQ-5D-5L and Decision Regret Scale (DRS) at 30 and 90 days postoperatively. Patients were also encouraged to describe their experience in a free text response which was subject to thematic analysis. EQ-5D-L responses were summarised as a health profile and transformed to an index using existing value sets. A repeated measures test was used to compare EQ-5D-5L results over time. A Mann-Whitney test was used for all other statistical analysis. Results Twenty patients were recruited with 15 patients completing follow-up at 90 days. The median age was 52 years and eleven were female. Fourteen patients were treated for ECF and 15 (75%) developed an SSI. EQ-5D responses indicated high levels of QoL impairment at baseline and 30 days which improved significantly by 90 days (mean difference 19.2, P = 0.0015). Patients with an ECF reported poor wound related QoL preoperatively (2.07) which improved at 30 (0.8; P = 0.0021) and 90 days (0.56; P = NS) after surgery. Global wound scores at 90 days were seven times higher amongst patients who developed an SSI (0.75 versus 0.11; P = NS). The mean preoperative DCS score was 15.79. Mean DRS scores at 30 and 90 day follow up were 15.56 and 9.67 respectively (P = NS). Free text responses were centred around four themes: anxiety about complications, the restoring power of surgery, the impact of infection, and the relationship with healthcare team. Conclusions This study provides novel insights into the patient experience following surgery for IF and the impact of SSI on patient reported outcomes. Patients undergoing surgery for IF experience relatively low levels of decision conflict and decision regret. Despite the high frequency of SSI following surgery for IF, most patients report improved generic and wound specific QoL scores when compared to before surgery. Future studies of SSI should include relevant PROMS to better understand the emotional and psychological impact of infective complications in differing clinical contexts.