Skip to main content
SpringerLink
Log in

Abdominal Surgery Impact Scale (ASIS) is Responsive in Assessing Outcome Following IPAA

  • original article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

Various generic and disease-specific quality of life instruments are available to assess outcome following surgery. However, they may not be sensitive to changes in outcome in the early postoperative period, which is important when assessing changes in surgical technique and perioperative care. The Abdominal Surgery Impact Scale (ASIS) is a validated instrument designed to assess short-term outcome following surgery. Thus, the aims of this study were to assess the impact of surgery on patients undergoing ileal pouch anal anastomosis (IPAA), assess factors which might impact on outcome, and lastly, further evaluate the reliability and internal consistency of the ASIS.

Methods

Patients over the age of 18 who had an IPAA between March 2005 and October 2007 completed the ASIS on postoperative day 3 and at the time of discharge. The ASIS contains 18 items within six domains with possible scores ranging from 18 to 126. Demographic, clinical and surgical data, postoperative complications, and length of stay were also recorded. Internal reliability of the ASIS was measured using Cronbach’s alpha coefficient.

Results

Ninety-two patients (36 female, 56 male, mean age = 36.8 ± 10.8) completed the ASIS at two time intervals (mean 3 days and mean 7 days postoperatively). Forty-seven patients had an IPAA performed with an ileostomy; 11 patients had the IPAA performed laparoscopically. The mean hospital stay was 10.8 days. The overall mean ASIS score significantly increased over the two time periods (mean 56.9 ± 18.3 vs. 81.8 ± 17.3, p < 0.001). Patients who had an ileostomy had a significantly lower mean score at discharge (77.32 vs. 86.82), secondary to lower scores on the physical limitations, functional impairment, and visceral function domains. Seven (7.8%) patients had ileo-anal anastomotic leaks, and seven (7.8%) patients had small bowel obstructions. These patients had an increased length of stay, whereas patients having laparoscopic surgery had a significantly shorter length of stay (8.8 days vs. 11.1 days), but there was no significant difference in mean ASIS scores. Cronbach’s alpha coefficient was 0.94 overall and ranged from 0.69 to 0.91 for subscales indicating internal reliability.

Conclusions

ASIS is a valid instrument for measuring quality of life in the postoperative period and is responsive to changes over time. Although quality of life increases postoperatively during hospital stay, at discharge, patients with IPAA still have decreased quality of life. Patients with ileostomies have further decreased scores.

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

Similar content being viewed by others

References

  1. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978;2(6130):85–88.

    Article  PubMed  CAS  Google Scholar 

  2. Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK. Ileal pouch–anal anastomoses complications and function in 1005 patients. Ann Surg 1995;222(2):120–127. doi:10.1097/00000658-199508000-00003.

    Article  PubMed  CAS  Google Scholar 

  3. Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH. J ileal pouch–anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 1998;85(6):800–803. doi:10.1046/j.1365-2168.1998.00689.x.

    Article  PubMed  CAS  Google Scholar 

  4. McMullen K, Hicks T, Ray J, Gathright JB, Timmcke AE. Complications associated with ileal pouch–anal anastomosis. World J Surg 1991;15:763–766. doi:10.1007/BF01665312.

    Article  PubMed  CAS  Google Scholar 

  5. Oresland T, Fasth S, Nordgren S, Hulten L. The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. Int J Colorectal Dis 1989;4(1):50–56.

    Article  PubMed  CAS  Google Scholar 

  6. Pemberton JH, Kelly KA, Beart RW Jr, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch–anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg 1987;206(4):504–513. doi:10.1097/00000658-198710000-00011.

    Article  PubMed  CAS  Google Scholar 

  7. Poppen B, Svenberg T, Bark T, Sjogren B, Rubio C, Drakenberg B, Slezak P. Colectomy–proctomucosectomy with S-pouch: operative procedures, complications, and functional outcome in 69 consecutive patients. Dis Colon Rectum 1992;35:40–47. doi:10.1007/BF02053337.

    Article  PubMed  CAS  Google Scholar 

  8. Skarsgard ED, Atkinson KG, Bell GA, Pezim ME, Seal AM, Sharp FR. Function and quality of life results after ileal pouch surgery for chronic ulcerative colitis and familial polyposis. Am J Surg 1989;157:467–471. doi:10.1016/0002-9610(89)90636-3.

    Article  PubMed  CAS  Google Scholar 

  9. Delaney CP, Fazio VW, Remzi FH, Hammel J, Church JM, Hull TL, Senagore AJ, Strong SA, Lavery IC. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch–anal anastomosis. Ann Surg 2003;238(2):221–228.

    PubMed  Google Scholar 

  10. Muir AJ, Edwards LJ, Sanders LL, Bollinger RR, Koruda MJ, Bachwich DR, Provenzale D. A prospective evaluation of health-related quality of life after ileal pouch anal anastomosis for ulcerative colitis. Am J Gastroenterol 2001;96(5):1480–1485. doi:10.1111/j.1572-0241.2001.03801.x.

    Article  PubMed  CAS  Google Scholar 

  11. Urbach DR, Harnish JL, McIlroy JH, Streiner DL. A measure of quality of life after abdominal surgery. Qual Life Res 2006;15(6):1053–1061. doi:10.1007/s11136-006-0047-3.

    Article  PubMed  Google Scholar 

  12. Huber PJ. Robust regression: asymptotics, conjectures and Monte Carlo. Ann Stat 1973;1(5):1799–1821.

    Article  Google Scholar 

  13. Lee AH, Gracey M, Wang K, Yau KK. A robustified modeling approach to analyze pediatric length of stay. Ann Epidemiol 2005;15(9):673–677. doi:10.1016/j.annepidem.2004.10.001.

    Article  PubMed  Google Scholar 

  14. Becker JM. Surgical therapy for ulcerative colitis and Crohn’s disease. Gastroenterol Clin North Am 1999;28(2):371–90. viii–ix doi:10.1016/S0889-8553(05)70061-3.

    Article  PubMed  CAS  Google Scholar 

  15. Calman KC. Quality of life in cancer patients—a hypothesis. J Med Ethics. 1984;10(3):124–127. doi:10.1136/jme.10.3.124.

    Article  PubMed  CAS  Google Scholar 

  16. Berndtsson I, Lindholm E, Oresland T, Borjesson L. Long-term outcome after ileal pouch–anal anastomosis: function and health-related quality of life. Dis Colon Rectum 2007;50(10):1545–1552. doi:10.1007/s10350-007-0278-6.

    Article  PubMed  Google Scholar 

  17. Berndtsson I, Oresland T. Quality of life before and after proctocolectomy and IPAA in patients with ulcerative proctocolitis—a prospective study. Colorectal Dis. 2003;5(2):173–179. doi:10.1046/j.1463-1318.2003.00455.x.

    Article  PubMed  CAS  Google Scholar 

  18. Thirlby RC, Sobrino MA, Randall JB. The long-term benefit of surgery on health-related quality of life in patients with inflammatory bowel disease. Arch Surg. 2001;136(5):521–527. doi:10.1001/archsurg.136.5.521.

    Article  PubMed  CAS  Google Scholar 

  19. Tiainen J, Matikainen M. Health-related quality of life after ileal J-pouch–anal anastomosis for ulcerative colitis: long-term results. Scand J Gastroenterol. 1999;34(6):601–605. doi:10.1080/003655299750026065.

    Article  PubMed  CAS  Google Scholar 

  20. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 2002;287(3):321–328. doi:10.1001/jama.287.3.321.

    Article  PubMed  Google Scholar 

  21. Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 2001;44(12):1800–18007. doi:10.1007/BF02234458.

    Article  PubMed  CAS  Google Scholar 

  22. Urbach DR. Laparoscopic-assisted surgery for colon cancer. JAMA 2002;287(15):1938. author reply 1939 doi:10.1001/jama.287.15.1938.

    Article  PubMed  Google Scholar 

  23. Camilleri-Brennan J, Munro A, Steele RJ. Does an ileoanal pouch offer a better quality of life than a permanent ileostomy for patients with ulcerative colitis? J Gastrointest Surg 2003;7(6):814–819. doi:10.1016/S1091-255X(03)00103-3.

    Article  PubMed  Google Scholar 

  24. Farouk R, Pemberton JH, Wolff BG, Dozois RR, Browning S, Larson D. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 2000;231(6):919–926. doi:10.1097/00000658-200006000-00017.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dr. Zane Cohen Digestive Diseases Clinical Research Center, Mount Sinai Hospital, Mount Sinai Hospital, Room 449, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada

    Indraneel Datta, Brenda O’Connor & Robin S. McLeod

  2. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada

    Robin S. McLeod

  3. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada

    J. Charles Victor

  4. Department of Surgery, University of Toronto, Toronto, Canada

    David R. Urbach & Robin S. McLeod

  5. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    David R. Urbach & Robin S. McLeod

Authors
  1. Indraneel Datta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brenda O’Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Charles Victor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David R. Urbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robin S. McLeod
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robin S. McLeod.

Appendix 1

Appendix 1

Abdominal Surgery Impact Scale (ASIS)

I cannot climb a flight of stairs

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I am not able to move easily

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I am not able to stand comfortably for five minutes

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

It is difficult for me to get dressed

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I am unable to care for myself

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I feel dependent on others to care for me

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I am afraid to move because it might cause pain

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I have severe pain in and around my abdomen

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

My incision(s) is/are causing me pain

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I am not able to move my bowels normally

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I am uncomfortable because I am thirsty

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I do not have a good appetite

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I wake up feeling that sleep has not refreshed me

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I have trouble falling asleep

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I wake up a lot in the night

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I have difficulty concentrating on what I am doing (conversation, watching TV, or reading)

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I feel helpless

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

I feel anxious

Strongly agree

Agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Disagree

Strongly disagree

  1. This questionnaire contains a number of statements that describe ways in which your abdominal surgery might have affected you. Please circle the most appropriate number to indicate the degree to which you agree or disagree with each statement. If you are unsure about how to answer a statement, please give the best answer you can. When answering each question, please think about how you have been feeling over the past day (24 hours).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Datta, I., O’Connor, B., Victor, J.C. et al. Abdominal Surgery Impact Scale (ASIS) is Responsive in Assessing Outcome Following IPAA. J Gastrointest Surg 13, 687–694 (2009). https://doi.org/10.1007/s11605-008-0793-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0793-3

Keywords

Search

Navigation