Positive Outcomes of Varicose Vein Surgery: The Patient Perspective

Patient-reported outcomes are increasingly recognized as important to understanding outcomes of medical interventions such as varicose vein surgery (VVS). Our aim was to compare positive outcomes of VVS as defined by several patient-reported measures, and to identify baseline characteristics associated with positive outcomes of VVS. A secondary analysis of the UK Patient-Reported Outcome Measures database was conducted on patients undergoing VVS, in the period 2009-2011 who completed the generic EQ-5D (index and visual analog scale [VAS] summary scores) and disease-specific Aberdeen varicose vein questionnaire (AVVQ). Surgical outcome was defined as positive if pre/post change scores exceeded half a standard deviation of mean baseline scores. Logistic regression models were used to identify significant predictors of positive outcomes, including age, gender, and baseline health. Of 9,113 patients analyzed (71 % females, 57 % aged > 50 years), positive outcomes were identified in 62 % using the AVVQ, 43 % based on EQ-5D index scores, and 24 % according to EQ-VAS; 10 % improved on all three measures. Patients with poorer baseline functioning (AVVQ scores a parts per thousand yen11) were more likely to have a positive outcome based on the EQ-5D index (odds ratio [OR] 1.23, 95 % confidence interval [CI] 1.11-1.36) and EQ-VAS (OR 1.30, 95 % CI 1.14-1.47). Defining surgery as successful will clearly depend on how health-related quality of life (HRQL) is operationalized and the criteria used to identify meaningful change. Across a range of criteria, a consistently greater proportion of patients had positive outcomes in terms of VV-related functioning (via AVVQ) compared with those who improved in terms of generic health (via EQ-index), or self-rated health (EQ-VAS).