Sense of coherence and other predictors of pain and health following laparoscopic cholecystectomy.
BACKGROUND
Pain is the most common symptom following laparoscopic cholecystectomy (LC) and might delay discharge from hospital after day surgery. A patient's ability to manage stressful situations can be assessed by the sense of coherence (SOC) and has been proposed to predict health. The aim of this study was to investigate predictors of average pain the first postoperative week after LC, and predictors of changes in perceived health, with special reference to individual coping resources measured by the Sense of Coherence Scale. Furthermore, a test-re-test was performed on SOC to evaluate the stability in the context of LC surgery.


METHODS
Seventy-three patients completed questionnaires about SOC, health status, pain, anxiety, symptom occurrence and symptom distress preoperatively, postoperative day 1-7 and after 1 and 6 months following LC.


RESULTS
By multiple regression, 23% of the variability in pain intensity could be explained by the variables age, SOC and education. Age was the strongest predictor. Further, 19% of the change in health between day 7 and 1 month could be explained by the two variables symptom distress the first postoperative day and SOC. The test-re-test of SOC had a correlation coefficient (r) of 0.55. Forty-six patients (63%) remained within ±10% of their preoperative SOC score at 6 months, 11 patients (15%) decreased and 16 patients (22%) increased their SOC values.


CONCLUSIONS
SOC was found to be a significant but weak predictor of pain intensity the first week after LC. Furthermore, patients scoring low SOC values experienced a delay in their health improvement. SOC was more unstable over time than previously suggested. Further, interventional studies are needed to clarify if SOC might be a clinically useful measure to identify vulnerable patients undergoing LC surgery.
Barthelsson
Cajsa
C
Department of Clinical Science, Intervention and Technology, Karolinska Institutet Stockholm, Sweden. cajsa.barthelsson@ki.se
Nordström
Gun
G
Norberg
Åke
Å
D000223:Adaptation, Psychological; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D006304:Health Status; D006801:Humans; D010146:Pain / Q000209:etiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D013548:Sweden