Consistency of patient-reported outcomes after cholecystectomy and their implications on current surgical practice: A prospective multicenter cohort study

Sarah Wennmacker, Mark Lamberts, Jos Gerritsen, J.A. Roukema, G.P. Westert, Joost Drenth, Cornelis van Laarhoven

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Abstract

Background:

Persistent postoperative pain (up to 41 %) and significant practice variation necessitate better patient selection for cholecystectomy. Patient-reported outcome measures (PROMs) are nowadays known to serve as a tool for better patient selection, although variability within these subjective outcomes may be a point for debate. This study determines associations of both the preoperative pain and patient characteristics with PROMs at 24 weeks after cholecystectomy. In order to evaluate variability of PROMs, we also determined consistency of these outcomes in time.

Methods:

This prospective multicenter cohort study included adult patients diagnosed with uncomplicated symptomatic cholecystolithiasis. Twenty-four weeks after surgery, a questionnaire study was carried out, containing Gastrointestinal Quality of Life Index (GIQLI) and Patients' Experience of Surgery Questionnaire. Results were compared to preoperative data and results 12 weeks post-cholecystectomy. Logistic regression analyses were performed to determine associations. Additional post hoc analysis on associations between preoperative selection criteria and PROMs was done.

Results:

A total of 360 patients (85 %) responded. Postoperative absence of pain was reported by 59.2 %. Associated characteristics were symptoms ≤1 year prior to surgery [OR 1.85 (95 % CI 1.11-3.09)] and high baseline GIQLI score [OR 1.04 (95 % CI 1.02-1.05)]. General improvement in abdominal symptoms and positive result of surgery were found in 90 %; no preoperative variables were significantly associated. PROMs showed consistency at 12 and 24 weeks postoperatively. Post hoc analysis showed no significant associations.

Conclusion:

PROM-based preoperative selection criteria need to be considered to select those patients who achieve freedom of pain after surgical treatment of uncomplicated symptomatic cholecystolithiasis. Other patients might consider cholecystectomy as successful, but are less likely to be free of pain. Usefulness of PROMs is underscored as they proved to be consistent in time in evaluating surgical outcome.

Original languageEnglish
Pages (from-to)215–224
JournalSurgical Endoscopy
Volume31
Issue number1
DOIs
Publication statusPublished - 2017

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Multicenter Studies
Patient Selection
Logistic Models

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Wennmacker, Sarah ; Lamberts, Mark ; Gerritsen, Jos ; Roukema, J.A. ; Westert, G.P. ; Drenth, Joost ; van Laarhoven, Cornelis. / Consistency of patient-reported outcomes after cholecystectomy and their implications on current surgical practice : A prospective multicenter cohort study. In: Surgical Endoscopy. 2017 ; Vol. 31, No. 1. pp. 215–224.
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title = "Consistency of patient-reported outcomes after cholecystectomy and their implications on current surgical practice: A prospective multicenter cohort study",
abstract = "Background: Persistent postoperative pain (up to 41 {\%}) and significant practice variation necessitate better patient selection for cholecystectomy. Patient-reported outcome measures (PROMs) are nowadays known to serve as a tool for better patient selection, although variability within these subjective outcomes may be a point for debate. This study determines associations of both the preoperative pain and patient characteristics with PROMs at 24 weeks after cholecystectomy. In order to evaluate variability of PROMs, we also determined consistency of these outcomes in time.Methods: This prospective multicenter cohort study included adult patients diagnosed with uncomplicated symptomatic cholecystolithiasis. Twenty-four weeks after surgery, a questionnaire study was carried out, containing Gastrointestinal Quality of Life Index (GIQLI) and Patients' Experience of Surgery Questionnaire. Results were compared to preoperative data and results 12 weeks post-cholecystectomy. Logistic regression analyses were performed to determine associations. Additional post hoc analysis on associations between preoperative selection criteria and PROMs was done.Results: A total of 360 patients (85 {\%}) responded. Postoperative absence of pain was reported by 59.2 {\%}. Associated characteristics were symptoms ≤1 year prior to surgery [OR 1.85 (95 {\%} CI 1.11-3.09)] and high baseline GIQLI score [OR 1.04 (95 {\%} CI 1.02-1.05)]. General improvement in abdominal symptoms and positive result of surgery were found in 90 {\%}; no preoperative variables were significantly associated. PROMs showed consistency at 12 and 24 weeks postoperatively. Post hoc analysis showed no significant associations.Conclusion: PROM-based preoperative selection criteria need to be considered to select those patients who achieve freedom of pain after surgical treatment of uncomplicated symptomatic cholecystolithiasis. Other patients might consider cholecystectomy as successful, but are less likely to be free of pain. Usefulness of PROMs is underscored as they proved to be consistent in time in evaluating surgical outcome.",
author = "Sarah Wennmacker and Mark Lamberts and Jos Gerritsen and J.A. Roukema and G.P. Westert and Joost Drenth and {van Laarhoven}, Cornelis",
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Consistency of patient-reported outcomes after cholecystectomy and their implications on current surgical practice : A prospective multicenter cohort study. / Wennmacker, Sarah; Lamberts, Mark; Gerritsen, Jos; Roukema, J.A.; Westert, G.P.; Drenth, Joost; van Laarhoven, Cornelis.

In: Surgical Endoscopy, Vol. 31, No. 1, 2017, p. 215–224.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Consistency of patient-reported outcomes after cholecystectomy and their implications on current surgical practice

T2 - A prospective multicenter cohort study

AU - Wennmacker, Sarah

AU - Lamberts, Mark

AU - Gerritsen, Jos

AU - Roukema, J.A.

AU - Westert, G.P.

AU - Drenth, Joost

AU - van Laarhoven, Cornelis

N1 - Geen affiliatie met TiU. Affiliatie: Department of SurgerySt. Elisabeth Hospital

PY - 2017

Y1 - 2017

N2 - Background: Persistent postoperative pain (up to 41 %) and significant practice variation necessitate better patient selection for cholecystectomy. Patient-reported outcome measures (PROMs) are nowadays known to serve as a tool for better patient selection, although variability within these subjective outcomes may be a point for debate. This study determines associations of both the preoperative pain and patient characteristics with PROMs at 24 weeks after cholecystectomy. In order to evaluate variability of PROMs, we also determined consistency of these outcomes in time.Methods: This prospective multicenter cohort study included adult patients diagnosed with uncomplicated symptomatic cholecystolithiasis. Twenty-four weeks after surgery, a questionnaire study was carried out, containing Gastrointestinal Quality of Life Index (GIQLI) and Patients' Experience of Surgery Questionnaire. Results were compared to preoperative data and results 12 weeks post-cholecystectomy. Logistic regression analyses were performed to determine associations. Additional post hoc analysis on associations between preoperative selection criteria and PROMs was done.Results: A total of 360 patients (85 %) responded. Postoperative absence of pain was reported by 59.2 %. Associated characteristics were symptoms ≤1 year prior to surgery [OR 1.85 (95 % CI 1.11-3.09)] and high baseline GIQLI score [OR 1.04 (95 % CI 1.02-1.05)]. General improvement in abdominal symptoms and positive result of surgery were found in 90 %; no preoperative variables were significantly associated. PROMs showed consistency at 12 and 24 weeks postoperatively. Post hoc analysis showed no significant associations.Conclusion: PROM-based preoperative selection criteria need to be considered to select those patients who achieve freedom of pain after surgical treatment of uncomplicated symptomatic cholecystolithiasis. Other patients might consider cholecystectomy as successful, but are less likely to be free of pain. Usefulness of PROMs is underscored as they proved to be consistent in time in evaluating surgical outcome.

AB - Background: Persistent postoperative pain (up to 41 %) and significant practice variation necessitate better patient selection for cholecystectomy. Patient-reported outcome measures (PROMs) are nowadays known to serve as a tool for better patient selection, although variability within these subjective outcomes may be a point for debate. This study determines associations of both the preoperative pain and patient characteristics with PROMs at 24 weeks after cholecystectomy. In order to evaluate variability of PROMs, we also determined consistency of these outcomes in time.Methods: This prospective multicenter cohort study included adult patients diagnosed with uncomplicated symptomatic cholecystolithiasis. Twenty-four weeks after surgery, a questionnaire study was carried out, containing Gastrointestinal Quality of Life Index (GIQLI) and Patients' Experience of Surgery Questionnaire. Results were compared to preoperative data and results 12 weeks post-cholecystectomy. Logistic regression analyses were performed to determine associations. Additional post hoc analysis on associations between preoperative selection criteria and PROMs was done.Results: A total of 360 patients (85 %) responded. Postoperative absence of pain was reported by 59.2 %. Associated characteristics were symptoms ≤1 year prior to surgery [OR 1.85 (95 % CI 1.11-3.09)] and high baseline GIQLI score [OR 1.04 (95 % CI 1.02-1.05)]. General improvement in abdominal symptoms and positive result of surgery were found in 90 %; no preoperative variables were significantly associated. PROMs showed consistency at 12 and 24 weeks postoperatively. Post hoc analysis showed no significant associations.Conclusion: PROM-based preoperative selection criteria need to be considered to select those patients who achieve freedom of pain after surgical treatment of uncomplicated symptomatic cholecystolithiasis. Other patients might consider cholecystectomy as successful, but are less likely to be free of pain. Usefulness of PROMs is underscored as they proved to be consistent in time in evaluating surgical outcome.

U2 - 10.1007/s00464-016-4959-x

DO - 10.1007/s00464-016-4959-x

M3 - Article

VL - 31

SP - 215

EP - 224

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

IS - 1

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