Post-cholecystectomy quality of life: a prospective multicenter cohort study of its associations with preoperative functional status and patient demographics

Propensity score matching analysis of perioperative outcomes including quality of life after multi-port vs. single port laparoscopic cholecystectomy: a nationwide prospective multicenter study in Korea

INTRODUCTION

The usefulness of single-port laparoscopic cholecystectomy (SPLC) as compared to multi-port laparoscopic cholecystectomy (MPLC) remains controversial. Between SPLC and MPLC, we compared outcomes, especially subjective aspects, such as quality of life (QoL).

MATERIAL AND METHODS

This multi-center study, involving 20 institutions from 2016 to 2017, enrolled 2507 patients who underwent laparoscopic cholecystectomy. Various perioperative outcomes, pain assessed by the numeric rating scale (NRS) score, and QoL evaluated by the gastrointestinal QoL index (GIQLI) questionnaire, were compared between the two procedures. We generated balanced groups after propensity score matching (PSM) using preoperative factors that influence the decision to perform MPLC or SPLC.

RESULTS

MPLC and SPLC were performed in 2176 and 331 patients, respectively. Nine hundred and twelve and 329 patients, respectively, were selected from the two groups by PSM. Operation time was longer and surgical difficulty was lower in SPLC. There were no significant differences in most outcomes, including biliary complications. Significant superiority of SPLC over MPLC was shorter hospitalization, lower NRS score, and favorable GIQLI.

CONCLUSIONS

From nationwide prospective data, SPLC showed outcomes comparable to MPLC. In SPLC, morbidity was not high and postoperative QoL was favorable. In the future, more implementations and studies are needed to ensure the safety and feasibility of SPLC.

Health-Related Quality of Life After Laparoscopic Cholecystectomy

Background

This study aimed to determine the mean improvement in the quality of life (QoL) after laparoscopic cholecystectomy (LC) in patients with symptomatic cholelithiasis.

Methodology

After obtaining approval from the hospital’s ethical committee, the Gastrointestinal Quality of Life Index (GIQLI) proforma was filled on admission (T0) and at week six (T1) postoperatively. All data were collected, and GIQLI scores were calculated for individual patients.

Results

In our study, among the 70 patients undergoing LC, 20% (n = 14) were aged 18-30 years and 80% (n = 56) were aged 31-60 years, with the mean ± standard deviation calculated as 41.56 ± 10.13 years. Overall, 44.29% (n = 31) of patients were men and 55.71% (n = 39) were women. GIQLI scores were 94.64 ± 2.24 for pre-treatment and 106.09 ± 2.40 for post-treatment, with a mean change of 11.44 ± 3.29, and a p-value of 0.001, showing a significant difference.

Conclusions

The mean improvement in QoL after LC in patients with symptomatic cholelithiasis is significantly higher when compared with pretreatment.

[Abdominal pain syndrome and quality of life in patients with cholelithiasis after cholecystectomy during a 10-year follow-up]

AIM

To estimate the incidence of abdominal pain syndrome (APS) and to assess quality of life (QOL) in patients within 10 years after cholecystectomy (CE).

SUBJECTS AND METHODS

This investigation is part of a long-term prospective follow-up study of patients after CE for cholelithiasis (CL). It enrolled 145 people: 30 (21.5%) patients with baseline asymptomatic CL and 115 (80.7%) with its clinical manifestations. The time course of changes in APS and QOL were analyzed.

RESULTS

Over 10 years, all the patients showed a decrease in the incidence of APS from 84.1% (n=95) to 66.4% (n=75; p=0.004). In Group 1 (n=89), APS was at baseline detected in all the patients; 10 years later, its incidence declined to 67.4% (n=60; p < 0.001). Biliary pains were predominant; these had been identified significantly less frequently over the 10-year period in 47 (52.8%) patients; p<0.001). In Group 2 (n=24), pre-CE APS was generally detected in 6 (25%) patients; following 10 years, the incidence rates of pain significantly increased to 62.5% (n=15; p=0.035), among which there were predominant biliary pains (in 54.2%; p<0.001) and dyspepsia from 33.3% (n=8) up to 66.7% (n=16; p=0.039). QOL in the physical and mental health domains was found to decrease in both groups.

CONCLUSION

Ten years after CE, the group with the baseline clinical manifestations of CL and poorer QOL showed a lower incidence of APS mainly due to the reduced incidence of biliary pains and the baseline asymptomatic group exhibited a rise in the incidence of APS due to the appearance of biliary pains and dyspepsia.

Effects of Intra-abdominally Instilled Isotonic Saline on Pain, Recovery, and Health-Related Quality-of-Life Following Laparoscopic Cholecystectomy: A Randomized Prospective Double-Blind Controlled Study

INTRODUCTION

The postoperative installation of isotonic saline in the abdomen has been suggested as a method to reduce the effect of local toxins, thereby reducing postoperative pain in patients undergoing laparoscopic surgery. The aim of this randomized prospective double-blind trial was to assess whether installation of isotonic saline can reduce postoperative pain and nausea following laparoscopic cholecystectomy (LC).

METHODS

Altogether 71 LC patients were randomized to either intra-abdominal instillation of isotonic saline group (S) (n = 36) or no saline (NS) group (n = 35) at the end of surgery. Data were collected by means of questionnaires. The postoperative recovery profile questionnaire was answered prior to surgery and 1 week postoperatively, SF-36 prior to surgery and at 1 month postoperatively, and a pain diary recording a Visual Analogue Scale score each day during the first week.

RESULTS

The overall response rate was 94%. No significant differences were seen between the groups regarding abdominal and shoulder pain. However, the NS group reported more pain (NS = 53 %, S = 29 %) and fatigue (NS = 50%, S = 35%) than the S group postoperative day 7. Moreover, the most frequently reported problem in both groups 7 days after surgery was getting back to normal life (60%). Females reported a slower recovery profile than males and also more postoperative symptoms day 7. HRQoL results were similar between the groups.

CONCLUSION

Instillation of isotonic saline does not improve recovery after laparoscopic cholecystectomy. Postoperative pain was more often reported in the NS group than in the S group, though the difference was not significant.

Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones

Background

Prior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD) after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database.

Methods

Using ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER) were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy.

Results

Of 6755 patients with gallstones, 173 (2.56%) were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient’s sex, age and geographic location, the hazard ratio (HR) of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02–2.04) for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08–2.41) for patients who underwent cholecystectomy compared to those who did not.

Conclusions

There is an association between cholecystectomy and subsequent risk of DD among females, but not in males.

[Evaluation of the gastrointestinal quality of life index as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy]

INTRODUCTION

We prospectively evaluated health-related quality of life (HRQoL) through the gastrointestinal quality of life index (GIQLI) as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy (LC) and its correlation with a linear prioritization system developed in the General and Gastrointestinal Surgery Institute of Clínica Quirón in Valencia.

MATERIAL AND METHODS

There were 100 consecutive patients who underwent elective outpatient LC. The main outcome measures consisted of: 1) assessment of the impact of the disease, measured through the GIQLI; 2) evaluation of an objective system based on technical scientific criteria; 3) evaluation of the utility of LC in improving HRQoL through the GIQLI by analyzing expected and obtained utility through the change ratio, and 4) analysis of the correlation between the objective linear system, HRQoL and utility.

RESULTS

The GIQLI was useful in evaluating the impact of the disease. LC significantly improved HRQoL in both oligosymptomatic and symptomatic patients. The objective or clinical factors did not allow perceptions of the process to be evaluated or the impact on HRQoL to be measured or inferred. A prioritization system based on GIQLI scores allows patients to be selected according to the expected utility (worsening of HRQoL) and obtained utility (improvement in HRQoL) of CL.

CONCLUSIONS

Prioritization systems should include utility to guarantee equity. The GIQLI shows the impact of the disease on the patient while the clinical/objective factors are unrelated to the expectation of prioritization. Prioritization systems should include both elements to maintain the balance between impact and appropriate indication.

Comparisons of prediction models of quality of life after laparoscopic cholecystectomy: a longitudinal prospective study

BACKGROUND

Few studies of laparoscopic cholecystectomy (LC) outcome have used longitudinal data for more than two years. Moreover, no studies have considered group differences in factors other than outcome such as age and nonsurgical treatment. Additionally, almost all published articles agree that the essential issue of the internal validity (reproducibility) of the artificial neural network (ANN), support vector machine (SVM), Gaussian process regression (GPR) and multiple linear regression (MLR) models has not been adequately addressed. This study proposed to validate the use of these models for predicting quality of life (QOL) after LC and to compare the predictive capability of ANNs with that of SVM, GPR and MLR.

METHODOLOGY/PRINCIPAL FINDINGS

A total of 400 LC patients completed the SF-36 and the Gastrointestinal Quality of Life Index at baseline and at 2 years postoperatively. The criteria for evaluating the accuracy of the system models were mean square error (MSE) and mean absolute percentage error (MAPE). A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and to rank the variables in order of importance. Compared to SVM, GPR and MLR models, the ANN model generally had smaller MSE and MAPE values in the training data set and test data set. Most ANN models had MAPE values ranging from 4.20% to 8.60%, and most had high prediction accuracy. The global sensitivity analysis also showed that preoperative functional status was the best parameter for predicting QOL after LC.

CONCLUSIONS/SIGNIFICANCE

Compared with SVM, GPR and MLR models, the ANN model in this study was more accurate in predicting patient-reported QOL and had higher overall performance indices. Further studies of this model may consider the effect of a more detailed database that includes complications and clinical examination findings as well as more detailed outcome data.

Health-related quality of life outcomes after cholecystectomy

Gallbladder diseases are very common in developed countries. Complicated gallstone disease represents the most frequent of biliary disorders for which surgery is regularly advocated. As regards, cholecystectomy represents a common abdominal surgical intervention; it can be performed as either an elective intervention or emergency surgery, in the case of gangrene, perforation, peritonitis or sepsis. Nowadays, the laparoscopic approach is preferred over open laparotomy. Globally, numerous cholecystectomies are performed daily; however, little evidence exists regarding assessment of post-surgical quality of life (QOL) following these interventions. To assess post-cholecystectomy QOL, in fact, documentation of high quality care has been subject to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. However, there has been little research published regarding QOL outcomes following cholecystectomy; in addition, much of the current literature lacks systematic data on patient-centered outcomes. Then, although several tools have been used to measure QOL after cholecystectomy, difficulty remains in selecting meaningful parameters in order to obtain reproducible data to reflect postoperative QOL. The aim of this study was to review the impact of surgery for gallbladder diseases on QOL. This review includes Medline searches of current literature on QOL following cholecystectomy. Most studies demonstrated that symptomatic patients profited more from surgery than patients receiving an elective intervention. Thus, the gain in QOL depends on the general conditions before surgery, and patients without symptoms profit less or may even have a reduction in QOL.

Dry needling for myofascial pain: prognostic factors

OBJECTIVES

The study objectives were to evaluate outcomes in patients who have received dry needling treatments and to identify predictors of pain and disability.

DESIGN

The study was a prospective cohort follow-up design.

SETTING

The study was conducted at the Pain Clinic at Pingtung Christian Hospital, Taiwan.

SUBJECTS

Ninety-two (92) patients sick-listed for 3 months or longer for myofascial pain syndrome.

INTERVENTIONS

From February to October 2008, participants were treated at the pain clinic with dry needling of trigger points and muscle stretches of the involved muscles.

OUTCOME MEASURES

Data were collected by self-administered questionnaires to assess changes in pain intensity and pain interference. Data collection was performed at baseline and after 2, 4, and 8 weeks. Sociodemographic variables, symptom characteristics, and baseline outcome measures were analyzed using generalized estimating equation methodology.

RESULTS

The proposed dry-needling protocol reduced pain intensity and pain interference. Long duration of pain symptoms, high pain intensity, poor quality of sleep, and repetitive stress were associated with poor outcomes.

CONCLUSIONS

Dry needling is an effective treatment for reducing pain and pain interference. However, long pain duration, high pain intensity, poor quality of sleep, and repetitive stress are associated with poor outcomes. Treatment outcome depends not only on the dry needling protocol, but also on disease characteristics and patient demographic profile.

Long-term outcomes of laparoscopic cholecystectomy: a prospective piecewise linear regression analysis

BACKGROUND

The objectives of this study were to examine longitudinal time trends, to predict thresholds of improvement in each dimension of health-related quality of life (HRQoL), and to identify long-term predictors of HRQoL.

METHODS

This study analyzed 353 laparoscopic cholecystectomy (LC) patients. Disease-specific Gastrointestinal Quality-of-Life Index (GIQLI) and generic Short-Form 36-Item Health Survey (SF-36) scores were obtained immediately before surgery, then 3, 6, 12, and 24 months after surgery. Generalized estimating equations and piecewise linear regression models were used.

RESULTS

The examined population significantly (p<0.05) improved in both SF-36 and GIQLI subscale scores. The HRQoL dimensions were substantially improved the sixth month after surgery and continued improving until they reached a plateau at 54.93 to 73.18 months. The data also showed the following explanatory variables for HRQoL: time, age, gender, Charlson Comorbidity Index, and preoperative GIQLI and SF-36 subscale scores.

CONCLUSIONS

As shown by the findings, the HRQoL scores improved substantially by the sixth month after surgery and continued improving until they reached a 4- to 7-year threshold, indicating that change trends in HRQoL dimensions may vary. Although HRQoL scores were substantially improved after cholecystectomy, the improvements were associated with preoperative functional status and demographic characteristics.

Health-related quality of life in patients undergoing cholecystectomy

This large-scale prospective cohort study of a Taiwan population applied generalized estimating equations to evaluate predictors of health-related quality of life (HRQOL) after open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) procedures performed between February 2007 and November 2008. The Gastrointestinal Quality of Life Index and Short Form-36 were used in a preoperative assessment and in 3(rd) month and 6(th) month postoperative assessments of 38 OC and 259 LC patients. The HRQOL of the cholecystectomy patients were significantly improved at 3 months and 6 months postsurgery (p<0.05). At 3 months postsurgery, HRQOL improvement was significantly larger in LC patients than in OC patients. Patient characteristics, clinical characteristics, and health care quality were also significantly related to HRQOL improvement (p<0.05). Additionally, after controlling for related variables, preoperative health status was significantly and positively associated with each subscale of the Gastrointestinal Quality of Life Index and Short Form-36 throughout the 6 months (p<0.05). Patients should be advised that their postoperative HRQOL may depend not only on their postoperative health care but also on their preoperative functional status.

Response shift effect on gastrointestinal quality of life index after laparoscopic cholecystectomy

PURPOSE

Traditional pre- and post-surgery quality of life assessments are inadequate for assessing change in health-related quality of life (HRQoL) after laparoscopic cholecystectomy (LC). This study examined whether a response shift, a change in the internal standards of a patient, occurs in patients who have received LC.

METHODS

Self-administered gastrointestinal quality of life index (GIQLI) was used to evaluate preoperative, postoperative, and retrospective postoperative HRQoL. Response shifts, unadjusted treatment effects, adjusted treatment effects, and their effect sizes were calculated.

RESULTS

In all GIQLI domains, a significant response shift was indicated by the significantly higher pre-test scores compared to then-test scores (P < 0.05). The effect size of the response shift ranged from 0.19 for the physical impairment domain of the GIQLI to 0.49 for the total GIQLI score. It was observed the treatment effect was greater after adjusting for the presence of response shift.

CONCLUSION

Patients who have received LC undergo a response shift that affects their outcome measurement at 6 months postoperative. Response shift is a potentially confounding factor and should be considered when designing clinical studies that employ self-administered HRQoL measures. This evidence of confounding effects warrants further study of response shift at longer intervals after LC, after other health care interventions, and in patients with varying preoperative health status.