Quality of Life After Surgery in Candidates of Laparoscopic and Open Cholecystectomy: A Comparison Study

摘要

Nowadays quality of life (QOL) is an important part of health and measuring health-related QOL after surgery is necessary for decision-making by patients and surgeons. To assess post cholecystectomy QOL, documentation of high quality care has been subjected to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. Objectives: The aim of this study was to compare quality of life after surgery in candidates of laparoscopic and open cholecystectomy. Patients and Methods: This study was an optional part of a longitudinal study for comparison of quality of life in candidates of laparoscopic (LC) and open cholecystectomy (OC). One hundred consecutive cases of hospitalized patients, aged 20 to 65 years, at two hospitals of Karaj, Iran (Imam Khomeini and Alborz), were recruited in the study from May to December 2011. Patients were divided to two groups based on the order of admission and the surgeons’ and patients’ preference. Patients were evaluated with the medical outcomes study 36-item short-form health survey (SF-36). Quality of life was measured at three points of time (the baseline was two and four weeks after surgery) using this health questionnaire. Differences between baseline time periods of two and four weeks were compared by independent-samples t-test and within groups the time periods were compared by the paired-sample t-test. Results: Two weeks after the operation, in the LC group, the QOL scores decreased significantly in physical functioning, physical status, body pain and emotional status (for all of them P ≤ 0.01), whereas, in the OC group all the aspect of QOL decreased (for all of them P < 0.01), with the exception of body pain (P = 0.982) and social functioning (P = 0.502). Four weeks after the operation, the QOL scores of the LC group, in every aspect increased and became significantly higher than the preoperative baseline (P < 0.001 for all parameters); while in the OC group only in the aspects of body pain (P < 0.001), general health (P = 0.003), and social functioning (P < 0.001) exceeded the preoperative level. Between-group analysis indicated that the LC group had significantly better outcome scores after four weeks compared to the OC group, in all aspects (P < 0.05 for all of them) with the exception of general health (P = 0.052). The results of the repeated measures analysis showed that there was a significant difference between the two groups during the three follow-up periods in the aspect of physical status (P = 0.008), vitality (P = 0.015), general health (P = 0.048) and emotional status (P = 0.003). Conclusions: Quality of life is an important factor affecting medical and surgical treatment, as well as decision-making. Improvement of short-term quality of life after laparoscopic cholecystectomy in comparison to open cholecystectomy proves the obvious superiority of LC over OC.