A prospective longitudinal cohort study for quality of life in patients undergoing fourth level liver surgery

• Published in: Scientific reports Vol. 15; no. 1; pp. 21035 - 7
• Main Authors: Xu, Xiaofeng, Xu, Jing, Xu, Gang, Lv, Tao, Yang, Jiayin
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2025; Nature Portfolio
• Subjects: 692/700; 692/700/784; Adult; Aged; EQ-5D-5L; Female; Fourth-level surgery; Hepatectomy; Humanities and Social Sciences; Humans; Liver - surgery; Longitudinal Studies; Male; Middle Aged; multidisciplinary; Prospective Studies; Quality of Life; Science; Science (multidisciplinary); Surveys and Questionnaires; EQ-5D-5L; Liver surgery; Fourth-level surgery; Quality of life
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-025-05771-x

Performing fourth-level liver surgery is an exceptionally demanding procedure, fraught with significant risks and technical complexities. Patients undergoing such operations face elevated surgical hazards, substantial physical trauma, prolonged recovery periods, and a multitude of factors that can profoundly impact their postoperative quality of life (QoL). Despite these challenges, there remains a notable gap in the literature regarding the long-term QoL outcomes for these individuals. This study seeks to evaluate the QoL of patients who have undergone fourth-level liver surgery and to identify key factors influencing their recovery. The findings aim to offer clinical insights that can enhance postoperative care and improve patient outcomes. Employing a prospective longitudinal cohort design, this study enrolled patients who received fourth-level liver surgery at a major tertiary hospital in Chengdu, affiliated with a university. QoL assessments were conducted using the EQ-5D-5L scale at three intervals post-discharge: one week, one month, and three months. This study enrolled 125 participants and tracked their health-related QoL using the EQ-5D-5L Utility Index (UI) (health utility values). Initially, 1 week post-discharge, most patients’ UI scores fell within the range of − 0.2 to 0.6. These values improved significantly over time, rising to 0.7–1.0 after 1 month and stabilizing between 0.8 and 1.0 by the 3 month mark. On average, patients reported experiencing pain for 4.18 days (± 9.72) following discharge. Statistical analyses—both univariate and multivariate—were performed to identify factors influencing QoL at different recovery stages. The findings revealed that admission method was a key determinant of QoL during the 1–3 month period post-discharge. Marital status emerged as a significant factor in the first week, while post-discharge pain levels primarily impacted QoL at the 1 month mark. After fourth-level liver surgery, the vast majority of patients regain their mobility, the ability to care for themselves, and their typical daily activities by 3 months post-discharge. Patients who are admitted to the emergency department tend to experience a lower QoL from 1 to 3 months following their discharge, compared to those who are admitted to the regular department. The persistent pain is a major culprit in diminishing a patient’s overall well-being. Consequently, prompt pain management and rehabilitation workouts are essential for expediting recovery and enhancing the patient’s QoL.