Comparison of the effect of primary and recurrent varicose vein surgery on symptoms and quality of life

Abstract

Abstract Background Surgeons are being increasingly asked to justify interventions for primary and particularly recurrent varicose veins (VVs). The effect of primary and recurrent VV surgery on disease-specific and generic quality of life (QoL) was compared. Methods This was a prospective study of 251 consecutive patients. Aberdeen VV symptom severity score (AVSS) (disease-specific) and Short Form 36 (SF-36) (generic) QoL questionnaires were completed before, and 4 weeks and 6 months after operation. Statistical analysis was by non-parametric methods. Results Some 77 per cent of patients with primary VVs (n = 130) and 74 per cent with recurrent VVs (n = 67) completed three questionnaires. Before operation, patients with recurrent VVs had significantly worse (higher) disease-specific QoL (median (interquartile range (i.q.r.)) AVSS 22·1 (14·6–29·7) versus 17·0 (11·3–24·5); P = 0·004) than those with primary VVs. At 4 weeks, the AVSS had only improved significantly in the primary group, but at 6 months was significantly improved in both primary (7·6 (3·1–14·7); P = 0·001) and recurrent (13·1 (7·8–19·5); P = 0·001) groups. Before operation, SF-36 emotional role (median (i.q.r.) 100 (33–100) versus 100 (100–100); P = 0·016) and vitality (58 (40–75) versus 65 (50–80); P = 0·026) were also significantly worse (lower) in the recurrent group. At 6 months, there was a significant improvement in bodily pain in both groups (primary 74 (51–100) versus 84 (62–100), P = 0·001; recurrent 62 (41–100) versus 74 (51–100), P = 0·007); and in physical functioning (85 (64–95) versus 93 (70–100); P = 0·001) and physical role (100 (50–100) versus 100 (94–100); P = 0·003) in patients with primary VVs. Conclusion Surgery for primary and recurrent VVs confers a highly significant improvement in disease-specific and, to a lesser extent, generic QoL.