Quality of Life of Urolithiasis Patients During the COVID-19 Pandemic: A Multi-Institutional Cross-Sectional Study

Translation and validation of the Italian version of the Wisconsin Stone Quality of Life Questionnaire (I-WISQOL) for assessing quality of life in patients with urolithiasis

BACKGROUND

Urolithiasis is a chronic condition, and it has been associated with a significant negative impact on patients' health-related quality of life (HRQOL). Several tools to assess patients' HRQOL have been validated in Italian, however disease-specific HRQOL instruments are still lacking. We aimed to develop and validate the Italian version of the WISQOL (I-WISQOL) in patients with urolithiasis.

METHODS

The Italian version of the WISQOL was developed in a multistep process involving primary translation, back-translation, and pilot testing among a group of patients (N.=10). Patients presenting with urolithiasis were prospectively recruited from the outpatient stone clinics and completed both questionnaire WISQOL and SF-36. Demographic information, as well as medical and surgical data, were obtained through an interview. Internal consistency of the I-WISQOL was obtained with Cronbach's α. Correlation of total scores of the I-WISQOL and SF36 was assessed to determine convergent validity using Spearman Rho. Correlations between clinical variables and results from the I-WISQOL were analyzed to descriptively assess the association of interest.

RESULTS

A total of 93 participants were evaluated and completed the Italian version of the I-WISQOL. The I-WISQOL demonstrated excellent internal consistency (Cronbach's α 0.95) and good convergent validity with the validated SF-36 (Spearman Rho r=0.70, P<0.001). Using ANOVA analysis, a significant decline in WISQOL Score was noted with the increasing number of renal colics (P=0.0543), ER visits (P=0.037), number of inpatient hospitalization (P=0.025). At multivariate analysis, worse WISQOL total score was predicted by a greater number of renal colic events (ß=-4.92 [-8.81-1.04], P=0.014) and by a greater number inpatient hospitalization (ß=-7.31 [-14.35 -0.26], P=0.042).

CONCLUSIONS

The I-WISQOL is an internally consistent and valid instrument to assess HRQOL in Italian-speaking patients with kidney stones. Its use in clinical practice should be implemented in order to tailor the management of each patient.

Standardizing perioperative medications to be used in an enhanced recovered after surgery (ERAS) program is feasible in percutaneous nephrolithotomy patients

INTRODUCTION

The objective of this process improvement project was to determine the effect of enhanced recovery after surgery (ERAS) protocol for percutaneous nephrolithotomy (PCNL) patients with respect to quality of life and pain management in the post-operative recovery period.

METHODS

An electronic-based medical record ERAS orders protocol for PCNL was instituted at an academic medical center in July of 2020. The protocol utilized a pain control regimen designed to minimize opioid medication use post-operatively. We prospectively evaluated PCNL patients' quality of life via the Wisconsin Stone Quality of Life survey (WISQOL) and Patient-Reported Outcomes Measurement System (PROMIS) at routine perioperative visits. To assess any opioid reduction benefit of the ERAS protocol, we reviewed an age-matched historical cohort n = 66 (prior to ERAS implementation) to serve as a comparison cohort with respect to opioid usage.

RESULTS

After an inception cohort of 95 patients, 55 ERAS patients remained available for assessment with the WISQOL and PROMIS surveys. In comparison to the non-ERAS cohort, the ERAS cohort represented larger stones, more supine positioning, higher blood loss, shorter hospital stay and more use of access sheath. ERAS patients received a significantly lower amount of opioids compared to non-ERAS patients upon discharge narcotic usage (116.13 morphine milliequivalent (MME) vs. 39.57 MME, p=0.0001). Compared to their pre-operative evaluation, the ERAS cohort had significantly improved quality of life scores at 1 week which sustained through 8 weeks post-operatively. Moreover, pain intensity and pain interference scores were improved at 8 weeks post-operatively for ERAS patients compared to their pre-operative time point.

CONCLUSIONS

We demonstrate that standardizing medications in early efforts towards a PCNL ERAS protocol is feasible and allows for reduced opioid use by patients while achieving early and sustained post-procedure quality of life.