Health-related quality of life and appropriateness of cholecystectomy.
OBJECTIVE
To evaluate the relationship among appropriateness of the use of cholecystectomy and outcomes.


BACKGROUND
The use of cholecystectomy varies widely across regions and countries. Explicit appropriateness criteria may help identify suitable candidates for this commonly performed procedure. This study evaluates the relationship among appropriateness of the use of cholecystectomy and outcomes.


METHODS
Prospective observational study in 6 public hospitals in Spain of all consecutive patients on waiting lists to undergo cholecystectomy for nonmalignant disease. Explicit appropriateness criteria for the use of cholecystectomy were developed by a panel of experts using the RAND appropriateness methodology and applied to recruited patients. Patients were asked to complete 2 questionnaires that measure health-related quality of life-the Short Form 36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI)-before the intervention and 3 months after it.


RESULTS
Patients judged as being appropriate candidates for cholecystectomy, using the panel's explicit appropriateness criteria, had greater improvements in the bodily pain, vitality, and social function domains of the SF-36 than those judged to be inappropriate candidates. They also demonstrated improvements in the GIQLI's physical impairment domain. Interventions judged as inappropriate were performed primarily among patients without symptoms of cholelithiasis. Those asymptomatic had a lower improvement in the bodily pain, social functioning, and physical summary scale of the SF-36 and in the symptomatology, physical impairment, and total score domains of the GIQLI.


CONCLUSIONS
These results suggest a direct relationship between the application of explicit appropriateness criteria and better outcomes, as measured by health-related quality of life. They also indicate that patients without symptoms are not good candidates for cholecystectomy.
Quintana
José Ma
JM
Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain. jmquinta@hgda.osakidetza.net
Cabriada
Jose
J
Aróstegui
Inmaculada
I
Oribe
Victor
V
Perdigo
Luis
L
Varona
Mercedes
M
Bilbao
Amaia
A
D000368:Aged; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013030:Spain; D016896:Treatment Outcome; D019564:Unnecessary Procedures