Patient Centered Outcomes Following Laparoscopic Cholecystectomy

Matthew Zapf, BA, Woody Denham, MD, Ermilo Barrera, MD, Zeeshan Butt, PhD, John Linn, MD, JoAnn Carbray, RN, Hongyan Du, MS, Michael Ujiki, MD

NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Northwestern University Feinberg School of Medicine

INTRODUCTION – Laparoscopic cholecystectomy is the second most common general surgical operation performed in the United States, yet little has been reported on patient centered outcomes during the long-term post-operative course. This study aimed to describe long-term quality of life outcomes in a cohort of these patients.

METHODS AND PROCEDURES – We prospectively followed 100 patients for two years after laparoscopic cholecystectomy as part of an Institutional Review Board-approved, multi-hospital, multi-surgeon study. The Surgical Outcomes Management System (SOMS) was used to quantify pain, bowel dysfunction, fatigue, cosmesis, physical function and overall satisfaction. SOMS scales were administered pre-operatively, at 24 hours, 72 hours, 1 week, 3 weeks, 6 months, 1 year and 2 years post-operatively. Patients were seen in clinic with physical exam up to two years post-op. A mixed-effect regression model was constructed with unspecified variance-covariance structure. Pair-wise comparisons were made between time points, and p-values were Bonferroni adjusted.

RESULTS – Maximum pain was reported 24 hours after surgery (19.7 ± 6.8), and decreased at each time point up to and including 3 weeks (All P<0.01). At 1 week post-op, patients reported equivalent pain to pre-op (11.6 ± 5.4 v 12.6 ± 4.4 P=0.37), and at 3 weeks (7.9 ± 3.2) they had significantly less pain than at pre-op (P<0.01). Bowel function worsened from pre-op to 1 week post-op (12.6 ± 4.4 v 14.8 ± 3.9 p=0.03), improved at week 3 (11.1 ± 3.4 p<0.01), and then remained constant at 6 months, (11.6 ± 4.2) and 1 year (11.5 ± 4.0). Twenty percent reported urgent or loose stools up to one year after surgery, which decreased to 11% at 2 years. Physical function worsened from pre-op (31.6 ± 6.2) to 1 week post-op (27.3 ± 5.4 P<0.01), but then surpassed pre-op levels during week 3 (33.6 ± 3.2 P=0.025), and was equivalent for the rest of the 2 year post-op course. Subjects reported returning to the activities of daily living after 6.2 ± 4.4 days and work after 11.1 ± 9.1 days. Patient-perceived cosmesis improved from post-op week 3 (5.2 ± 1.8) to 6 months (4.7 ± 1.6 P=0.026) when 72% reported that the procedure had no effect on cosmesis, and then remained unchanged through 2 years. Fatigue increased from pre-op (15.9 ± 6.1) to week 1 (20.8 ± 6.3 P<0.01) before improving (13.8 ± 5.2 P=0.025) at week 3, where it remained equivalent through 2 years. Satisfaction with the procedure was high, averaging 9.44 out of a max score of 11, and was equivalent across post-op week 3, 6 months, 1 year and 2 years.

CONCLUSIONS – Physical function, pain, fatigue and bowel function surpassed pre-operative levels by week three. Satisfaction with the procedure and cosmesis were high throughout and maximum cosmesis was achieved by 6 months post-op.

Session: Podium Presentation

Program Number: S090