Patient-centered outcomes after laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy (LC) is the second most common general surgical operation performed in the United States, yet little has been reported on patient-centered outcomes.


METHODS
We prospectively followed 100 patients for 2 years as part of an institutional review board-approved study. The Surgical Outcomes Measurement System (SOMS) was used to quantify quality-of-life (QoL) values at various time points postoperatively.


RESULTS
Maximum pain was reported at 24 h (5.5 ± 2.2), and decreased to preoperative levels at 7 days (1.2 ± 2.3 vs. 2.0 ± 1.6, P = 0.096). Bowel function improved from before the operation to 3 weeks after surgery (10.7 ± 3.8 vs. 12.0 ± 3.2, P < 0.05), but then regressed to preoperative levels. Physical function worsened from before surgery (31.7 ± 6.2) to 1 week (27.5 ± 5.9, P < 0.0001), but surpassed preoperative levels at 3 weeks (33.5 ± 3.4, P < 0.01). Return to the activities of daily living occurred at 6.3 ± 4.7 days and work at 11.1 ± 9.0 days. Fatigue increased from before surgery (15.8 ± 6.2) to week 1 (20.7 ± 6.6, P < 0.0001) before improving at week 3 (14.0 ± 5.8, P < 0.01). Forty-four patients contacted the health care team 61 times before their 3 weeks appointment, most commonly for wound issues (26.2%), pain (24.6%), and gastrointestinal issues (24.6%). Seventy-two percent reported that the procedure had no negative effect on cosmesis at 6 months. Satisfaction with the procedure was high, averaging 9.52 out of 11.


CONCLUSIONS
QoL is significantly affected in the 24 h after LC but returns to baseline at week 3. Cosmesis and overall satisfaction are high, and QoL improvements are maintained in the long term except for bowel function, which regresses to preoperative levels of impairment. Analysis of patient-initiated contacts after LC may provide feedback on discharge counseling to increase patient satisfaction.
Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, USA, matthewzapf@gmail.com.
Matthew
M
Zapf
Woody
W
Denham
Ermilo
E
Barrera
Zeeshan
Z
Butt
JoAnn
J
Carbray
Chih
C
Wang
John
J
Linn
Michael
M
Ujiki
D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology