Objective of Study
Post-operative pain, fatigue, circadian disturbances & well-being are cardinal patient reported outcome (PRO) measures indicating desired/ expected Health related Quality of Life (HrQoL) improvement after Laparoscopic Cholecystectomy (LC). These PROs result from a cascade of inflammatory and metabolic stress responses to surgery. Energised dissection (ED) in LC may excite these inflammatory & stress pathways as ED isn’t physiologically inert. We studied the effect of ED on PROs after LC.
Methods and procedures
Consecutive unselected candidates for day care LC (March 2007-Feb 2009) were enrolled following Ethics/ Informed Consent Protocol to be allocated to Study group i.e. LC without ED (LC-ED; those consulting us in the morning clinic) and the Control Group i.e. LC with ED (LC+ED; those consulting us in the evening clinic). A standard anesthesia / antibiotic/ analgesia / surgery & discharge protocol was followed.
| Study End Point | Measuring Scale |
|---|---|
| HrQoL | 100-point; 36-items;8-subscale SF-36 generic measure |
| Nausea | 0-no nausea; 1-some; 2-moderate; 3-severe; 4-vomiting |
| Pain | no pain-worst @100 point visual analog scale (VAS) |
| Sleep Quality | worst – best sleep @ 0-100-mm VAS-assessed at 8am. |
| Well Being | 100-mm VAS-assessed in evening at 8pm. |
| Discharge Willingness | 4 point Likert scale i.e.1-donot want to go; 2-will go if all is definitely well; 3-will go if doctor insists; 4-want to go |
| Fatigue | 10-point Christensen fatigue scale; 1 = fit, 10 = fatigued |
Prospective data collected pre-operatively (P0) & post-operatively on Day1 (D1), Day2 (D2), Day3 (D3), 1st week (W1), 2nd week (W2) & 3rd week (W3).
Results
The Study (53) & Control (93) groups were well matched for demographic, activity, co-morbidity and gallbladder inflammation parameters. There were no adverse events or failure to discharge from day care although control group patients were extremely reluctant. Patient noncompliance led to withdrawal of 9 & 17 patients leaving 44 (study) & 76 (control) for analysis. Only patients of LC+ED reported right sided scapulo-costal & shoulder tip pain predominating up to D3, patients of LC-ED didn’t report this at all.
| Nausea |
Pain |
Fatigue | ||||||||
| Follow-up | D1 |
D2 | D3 |
D3 | W1 |
W3 |
D3 |
W1 | W3 | |
| Control (LC+ED) | 3 | 2 | 0.5 | 66 | 40 | 20 | 10 | 9 | 4 | |
| Study (LC-ED) | 1.5 | 0.5 | 0 | 42 | 21 | 18 | 6 | 3 | 1.2 | |
| Group /Follow-up |
Sleep Quality |
General Well-Being |
Discharge Willingness |
||||
| D1 | D2 | D3 | D3 | W1 |
W3 | ||
| Control (LC+ED) | 22 | 45 | 60 | 50 | 60 | 82 | 1.8 |
| Study (LC-ED) | 28 | 70 | 90 | 70 | 84 | 94 | 3.6 |
| * | PF | RP | BP | GHP | VI | SF | RE | MH |
| P0 | 80(90) | 70(75) | 60(60) | 66(65) | 55(60) | 45(65) | 80(75) | 80(78) |
| W1 | 60(80) | 35(65) | 60(80) | 70(90) | 45(65) | 50(90) | 80(80) | 80(80) |
| W3 | 65(85) | 45(70) | 90(95) | 75(95) | 55(65) | 70(95) | 80(80) | 80(80) |
*PF-physical functioning; RP-role physical; BP-bodily pain; GHP-general health perception; VI-vitality; SF-social functioning; RE-role emotional; MH-mental health
Conclusion
Patient reported outcomes are better after laparoscopic cholecystectomy without energized dissection benefitting the global sense of well being.
Session: Poster
Program Number: P421