title: Consistency of patient-reported outcomes after cholecystectomy and their implications on current surgical practice: a prospective multicenter cohort study.
abstract: Persistent postoperative pain (up to 41 %) and significant practice variation necessitate better patient selection for cholecystectomy. Patient-reported outcome measures (PROMs) are nowadays known to serve as a tool for better patient selection, although variability within these subjective outcomes may be a point for debate. This study determines associations of both the preoperative pain and patient characteristics with PROMs at 24 weeks after cholecystectomy. In order to evaluate variability of PROMs, we also determined consistency of these outcomes in time.
  
  
  
  This prospective multicenter cohort study included adult patients diagnosed with uncomplicated symptomatic cholecystolithiasis. Twenty-four weeks after surgery, a questionnaire study was carried out, containing Gastrointestinal Quality of Life Index (GIQLI) and Patients' Experience of Surgery Questionnaire. Results were compared to preoperative data and results 12 weeks post-cholecystectomy. Logistic regression analyses were performed to determine associations. Additional post hoc analysis on associations between preoperative selection criteria and PROMs was done.
  
  
  
  A total of 360 patients (85 %) responded. Postoperative absence of pain was reported by 59.2 %. Associated characteristics were symptoms ≤1 year prior to surgery [OR 1.85 (95 % CI 1.11-3.09)] and high baseline GIQLI score [OR 1.04 (95 % CI 1.02-1.05)]. General improvement in abdominal symptoms and positive result of surgery were found in 90 %; no preoperative variables were significantly associated. PROMs showed consistency at 12 and 24 weeks postoperatively. Post hoc analysis showed no significant associations.
  
  
  
  PROM-based preoperative selection criteria need to be considered to select those patients who achieve freedom of pain after surgical treatment of uncomplicated symptomatic cholecystolithiasis. Other patients might consider cholecystectomy as successful, but are less likely to be free of pain. Usefulness of PROMs is underscored as they proved to be consistent in time in evaluating surgical outcome.
authors.affiliation: Department of Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. sarah.wennmacker@radboudumc.nl.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wennmacker
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Lamberts
authors.affiliation: Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Gerritsen
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Jan Anne
authors.initials: JA
authors.lastname: Roukema
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Gert
authors.initials: G
authors.lastname: Westert
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Drenth
authors.affiliation: Department of Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: van Laarhoven
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000328:Adult; D002763:Cholecystectomy; D041761:Cholecystolithiasis / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Cholecystectomy; Cholecystolithiasis; Gallstones; Patient-reported outcomes; Selection criteria