Minimally invasive surgery preserves HRQoL, physical function better than median sternotomy

Minimally invasive (MI) surgery improves health-related quality of life (HRQoL) and early functional outcomes compared to median sternotomy (MS), even in frail patients, a recent study has found.

The researchers conducted a multicentre prospective cohort study of 100 consecutive patients undergoing MI surgery (n=50; mean age 73±10.2 years, 44 percent men) or MS (n=50; mean age 69±11.5 years, 76 percent men). Outcomes included HRQoL, measured using a visual analogue scale (VAS) and the five-level EQ-5D (EQ-5D-5L), and physical activity before and after surgery, assessed through a wearable accelerometer.

At baseline, QoL index scores were comparable between treatment groups (p=0.2), while VAS was significantly lower in MI patients (p<0.001). However, 3 months after the procedure, both QoL index (0.6±0.2 vs 0.4±0.2; p<0.001) and VAS (64.6±12.8 vs 62.3±11.2; p=0.002) became significantly greater in MI patients. At 6 and 12 months, no significant between-group QoL differences were reported.

A similar pattern of effect was reported for physical activity, which was significantly lower overall in MI than in MS patients at baseline (p<0.001). But during the postoperative period, MS patients showed a significantly larger reduction in physical activity than MI comparators (p<0.001 and p=0.02 for light and moderate physical activity, respectively).

 In a subsequent subanalysis on frail patients, the researchers also found that QoL index and VAS scores were better in the MI vs MS groups. Physical activity was likewise lower at baseline in MI patients but showed greater postoperative recovery than in MS counterparts.

“Taken together, these findings suggest that MI may be beneficial for preserving QoL and PA postprocedure, especially in frail patients,” the researchers said.