Skip to main content

Advertisement

SpringerLink
Log in

Assessing patient-reported outcomes of cholecystectomy in short-stay surgery

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for cholecystectomy.

Methods

In two centers for short-stay surgery, patients referred for laparoscopic cholecystectomy were surveyed between Aug 1999 and Jan 2002. Patients reported on health-related quality of life (SF-36), symptoms (gallstone symptom checklist, GSCL) and other indicators preoperatively (T0), 14 days (T1) and 6 months postoperatively (T2). The SF-36 subscales physical functioning, bodily pain, and role physical as well as the GSCL and treatment satisfaction at T2 were considered as main outcomes. The main outcomes were analyzed by generalized linear models with regard to predictors.

Results

At T0 a total of 205 patients were included. The response rate at T2 was 63.4% (74.6% females, 53.6 years of age). The GSCL score at T0 (29.4% preoperatively) fell slightly to 27.9% at T1 and decreased to 14.8% at T2 (T0–T2: p < 0.001). The SF-36 subscales showed a different course over time (decrease of health-related quality of life at T1 and large increase at T2). The level of satisfaction with the outcome of cholecystectomy was 82.3%. The patient-reported outcomes were mainly influenced by the preoperative level, age and self-reported postoperative complaints.

Conclusion

The low response rate was mainly due to nondelivery of questionnaires at T1 during the regular postoperative visit by the operating physician. Though nonresponse occurs under conditions of routine care, meaningful information was gained, which should be used for quality improvement activities. Because the preoperative level is a major determinant of the postoperative health outcomes, the prospective pre–post measurement should be preferred if institutional comparisons are intended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BP:

Bodily pain

GHP:

General health perception

GSCL:

Gall stone symptom checklist

MH:

Mental health

PF:

Physical functioning

RE:

Role emotional

RP:

Role physical

SF:

Social functioning

SF-36:

Short form-36

VI:

Vitality

References

  1. Bardsley MJ, Venables CW, Watson J, Goodfellow J, Wright PD (1992) Evidence for validity of a health status measure in assessing short term outcomes of cholecystectomy. Qual Health Care 1:10–14

    Article  PubMed  CAS  Google Scholar 

  2. Berthou J, Dron B, Charbonneau P, Moussalier K, Pellissier L (2007) Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients: indications and results. Surg Endosc. doi:10.1007/s00464-007-9387-5, May 24, 2007

  3. Bitzer EM, Grobe TG, Dörning H, Schwartz FW (2006) GEK-Report akut-stationäre Versorgung 2006. Asgard, St. Augustin

    Google Scholar 

  4. Bitzer EM, Nickel S, Lorenz C, Dörning H, Trojan A (2006) Prozess- und ergebnisorientiertes Qualitätsmanagement in der Kurzzeitchirurgie mit Patientenbefragungen. Z Ärztl Fortbild Qualitätssich 100:189–195

    PubMed  Google Scholar 

  5. Black NA, Thompson E, Sanderson CFB, ECHSS Group (1994) Symptoms and health status before and after six weeks after open cholecystectomy: a European cohort study. Gut 35:1301–1305

    Google Scholar 

  6. BQS-Bundesgeschäftsstelle Qualitätssicherung (2007) BQS-Bundesauswertung 2006 - Cholezystektomie. BQS-Outcome. Available at: http://www.bqs-outcome.de/2006/ergebnisse/leistungsbereiche/cholezystektomie/bu_Gesamt_12n1_2006_9n0.pdf. Accessed 15 February 2007

  7. Bullinger M (1996) Erfassung der gesundheitsbezogenen Lebensqualität mit dem SF-36 Health Survey: Hinweise auf Bewertungsinstrumente zur Qualitätssicherung in der Rehabilitation - Blatt 7. Rehabilitation 35:XVII–XXXX

  8. Bullinger M, Kirchberger I (1998) Der SF-36 Fragebogen zum Gesundheitszustand. Handanweisung. Hogrefe, Göttingen

    Google Scholar 

  9. Burney RE, Jones KR (2002) Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health status. Surg Endosc 16:921–926

    Article  PubMed  CAS  Google Scholar 

  10. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222

    Article  PubMed  CAS  Google Scholar 

  11. Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R (2002) Quality of life measurement: bibliographic study of patient assessed health outcome measures. Br Med J 324:1417

    Article  Google Scholar 

  12. Höfler M, Pfister H, Lieb R, Wittchen HU (2005) The use of weights to account for non-response and drop-out. Soc Psychiatr Psychiatr Epidemiol 40:291–299

    Article  Google Scholar 

  13. Junginger T, Küchle R, Dutkowski P, Thumerer A (1998) Systematische klinikinterne Qualitätskontrolle in der Chirurgie 1993 bis 1997. Z. Ärztl. Fortbild. Qualitätssich 92:705–714

    PubMed  CAS  Google Scholar 

  14. Kohlmann T, Steinke I, Berger K, Deck R, John J, Pohlabeln H, Rieger J, Nickel S, Uhlig S (2000) Empfehlungen zur Auswahl und Anwendung von Erhebungsinstrumenten und Auswertungsverfahren in der Public Health-Forschung. Public Health Forum 8:11–13

    Google Scholar 

  15. Lienert GA, Raatz U (1998) Testaufbau und Testanalyse. Beltz, Psychologie-Verl.-Union, Weinheim

    Google Scholar 

  16. McCullagh P, Nelder JA (1989) Generalized linear models, 2nd edn. Chapman and Hall, London

    Google Scholar 

  17. Norman GR, Wyrwich KW, Patrick DL (2007) The mathematical relationship among different forms of responsiveness coefficients. Qual Life Res 16:815–822

    Article  PubMed  CAS  Google Scholar 

  18. Rubin DB (1987) Multiple imputation for nonresponse in surveys. Wiley, New York

    Google Scholar 

  19. Schafer JL (1997) Analysis of incomplete multivariate data. Monographs on Statistics and Applied Probability 72. Chapman and Hall, New York

    Google Scholar 

  20. Schwartz FW, Bitzer EM, Dörning H, Walter U (2002) Evaluation und Qualitätsmanagement. In: Hurrelmann K, Laser E (Hg) Handbuch für Gesundheitswissenschaften. Juventa, Weinheim

  21. Topcu O, Karakayali F, Kuzu MA, Ozdemir S, Erverdi N, Elhan A, Aras N (2003) Comparison of long-term quality of life after laparoscopic and open cholecystectomy. Surg Endosc 17:291–295

    Article  PubMed  CAS  Google Scholar 

  22. Troidl H, Kusche J, Vestweber KH, Eypasch E, Koeppen L, Bouillon B (1987) Quality of life: an important endpoint both in surgical practice and research. J Chronic Dis 40:523–528

    Article  PubMed  CAS  Google Scholar 

  23. Velanovich V (2000) Laparoscopic vs open surgery: a preliminary comparison of quality-of-life outcomes. Surg Endosc 14:16–21

    Article  PubMed  CAS  Google Scholar 

  24. Victorzon M, Tolonen P, Vuorialho T (2007) Day-case laparoscopic cholecystectomy: treatment of choice for selected patients? Surg Endosc 21:70–73

    Article  PubMed  CAS  Google Scholar 

  25. Wright CJ, Chambers GK, Robens-Paradise Y (2002) Evaluation of indications for and outcomes of elective surgery. CMAJ 167:461–466

    PubMed  Google Scholar 

Download references

Acknowledgements

We like to thank both cooperating surgical units, the Interdisciplinary Centre for Short-Stay Surgery at the Klinikum Nord-Heidberg and the Short-Stay Unit of the Klinik Eilbek, both located in Hamburg. The study was funded within the Northern German Public Health Research Association by the Federal Ministry of Education, Science, Research and Technology (Grant ID: 01 EG 9814/9).

Author information

Authors and Affiliations

  1. ISEG – Institute for Social Medicine, Epidemiology and Health System Research, Lavesstr. 80, 30159, Hannover, Germany

    Eva Maria Bitzer, Christoph Lorenz & Hans Dörning

  2. Department of Medical Sociology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Stefan Nickel & Alf Trojan

Authors
  1. Eva Maria Bitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Nickel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans Dörning
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alf Trojan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva Maria Bitzer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bitzer, E.M., Lorenz, C., Nickel, S. et al. Assessing patient-reported outcomes of cholecystectomy in short-stay surgery. Surg Endosc 22, 2712–2719 (2008). https://doi.org/10.1007/s00464-008-9878-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9878-z

Keywords

Search

Navigation