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Patient-Reported Quality of Life Following Laparotomy in a Resource-Limited Setting

  • Surgery in Low and Middle Income Countries
  • Published:
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Abstract

Introduction

The burden of surgical diseases is high in sub-Saharan Africa. Despite limitations to surgical care access, health-related quality of life (HRQoL) data following surgical intervention are scarce.

Methods

We performed a 3-month prospective observational study of adult patients undergoing an abdominal operation. We administered the Patient-Reported Outcome Measurement Information System (PROMIS)-25 and Index of Independence in Activities of Daily Living questionnaire preoperatively (to postoperative day [POD] #1), POD#7, and POD#30. PROMIS-25 HRQoL domains were measured and converted to standardized T-scores (median 50, minimal important clinical difference 3).

Results

Of the 117 laparotomy patients who were enrolled, 89 (76.1%) were male with a median age of 39 years (IQR 27–54). Operations were primarily for intestinal volvulus (n = 30, 28.3%) and intestinal perforation (n = 29, 27.4%). We completed a total of 80 (68.4%), 95 (81.2%), and 77 (65.8%) surveys preoperatively, at POD#7, and POD#30, respectively. Preoperatively patients showed high median levels of anxiety (56), depression (60), fatigue (63), and pain interference (62), which all improved postoperatively. Mobility was poor preoperatively (31) and showed improvement during recovery but remained poor [POD#7: 32, POD#30: 39]. Pain intensity was high (10/10) preoperatively and improved to 3/10 by POD#30. Patients with complications compared to those without had clinically significant worse HRQoL in all domains measured by POD#30.

Discussion

Abdominal surgery patients in a resource-limited setting present with poor HRQoL, which improves postoperatively. Mobility remained poor throughout follow-up despite improved pain scores. Our findings highlight the need for improved HRQoL and pain control among surgical patients.

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Acknowledgment

We will like to thank the leadership and staff of the Department of Surgery at Kamuzu Central Hospital.

Funding

This study was supported in part by the NIH Fogarty International Center Postdoctoral Research Fellowship to Dr. Purcell.

Author information

Authors and Affiliations

  1. Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Laura N. Purcell & Anthony Charles

  2. School of Medicine, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, Chapel Hill, CB, 7228, USA

    Rachel Reiss & Anthony Charles

  3. University of North Carolina Project-Malawi, Lilongwe, Malawi

    Mercy Mtalimanja, Patricia Kuyenda & Katherine D. Westmoreland

  4. Pediatric Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Katherine D. Westmoreland

  5. Kamuzu Central Hospital, Lilongwe, Malawi

    Vanessa Msosa & Anthony Charles

Authors
  1. Laura N. Purcell
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  2. Rachel Reiss
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  3. Mercy Mtalimanja
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  4. Patricia Kuyenda
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  5. Vanessa Msosa
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  6. Katherine D. Westmoreland
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  7. Anthony Charles
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Correspondence to Anthony Charles.

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Informed consent was obtained from all individual patients or patient's guardians included in the study.

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Purcell, L.N., Reiss, R., Mtalimanja, M. et al. Patient-Reported Quality of Life Following Laparotomy in a Resource-Limited Setting. World J Surg 45, 1971–1978 (2021). https://doi.org/10.1007/s00268-021-06050-2

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  • DOI: https://doi.org/10.1007/s00268-021-06050-2

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