Comparative Pateint Reported Well Being After Laparoscopic Cholecystectomy Performed with or Without Energised Dissection-A Case Controlled Study

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.

Post-operative mean scores

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
Mean Scores- Sleep, Well-being & Discharge Willingness

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

Mean HrQoL scores*–Control (Study)

* 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

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