P629 Impact of surgical treatment on quality of life in Crohn’s disease: Short-and longer-term follow-up

Abstract

Symptoms of active CD have a substantial impact on health-related quality of life (HRQoL). Even in the absence of active disease, CD patients report worse HRQoL. Achievement of disease remission, whether by medical therapies or surgery, is associated with an improvement of quality of life (QoL). Medical management not rarely is associated to side effects, hospitalisation, long treatment period and requires patient compliance, with impact on QoL. Surgery is often required, in the form of ileo-colic resection (ICR), open or laparoscopic. Aim of the study was to assess changes of QoL following ICR, and to identify specific factors, patient and disease-related, impacting on QoL in the short- and longer term. We analysed data from a prospective database of patients undergoing ICR from 01/2009 to 08/2017. Data included duration of CD, disease features, demographics, habits and comorbidities. We assessed medical therapies before surgery (steroids/biologics), open and laparoscopic technique. Quality of life (QoL) was analysed with the Cleveland Global Quality of Life (CGQL) Score, recording the three items: Current Quality of Life (CQoL), Current Quality of Health (CQoH), Current Energy Level (CEL). In addition, the Overall Quality of Happiness (OQH) was recorded and patients answered the question if they would have surgery again and/or they recommend the treatment to others. CGQL Scores and OQH were compared according to timing of follow-up, surgical technique, medical treatment, and demographics. One hundred and thirteen patients were considered for analysis. Demographics and pre-operative data were similar among the groups. Fifty-two (46%) patients had laparoscopy and 61 (54%) laparotomy. Both at 30 days and 6 months after surgery we observed a significant increase of CGQL (p < 0.0001). Incremental values were also recorder at 1 and 3 years with a minor increase. Significant improvement was observed in all the three items composing the CGQL (p < 0.0001). This was also confirmed from the OQH. 88% of patients would undergo surgery again or recommend it. Laparoscopy was associated with better CGQL scores. Steroids before surgery showed a significant minor improvement in CGQL. Positive factors for QoL improvements were young age, female gender, penetrating disease. QoL of patients with CD is lower than normal ranges. Medical treatments often are not able to keep symptoms under control, and surgery is required. Surgical treatment is able to remove the diseased bowel, and is associated with a clear improvement of all the items related with QoL. Laparoscopy seems to guarantee greater results.