The impact of surgery on health related quality of life in Crohn's disease

Abstract

When patients with Crohn's disease (CD) express concerns about their disease, they emphasize worries about surgery. However, postsurgical changes in health related quality of life (HRQOL) in patients with CD have been barely studied, and published results are somewhat discrepant. In the present study we assessed whether surgical treatment of refractary or complicated CD modifies HRQOL. Outcomes of 27 patients with previous intestinal or colonic resection were compared to 39 non-operated patients and to a reference control group of 63 healthy individuals. All patients were in clinical remission at the time of study. Age and sex were similar in the three groups. Mean CD recurrence/year index was similar for operated and nonoperated patients, but the interval from diagnosis to interview was longer in operated patients (median [95% CI]: 100 [81-160] months vs 48 [46-78], p<0.01). HRQOL was assessed by a validated spanish version of the Inflammatory Bowel Disease Questionnaire (IBDQ), that included five dimensions: intestinal symptoms, general symptoms, emotional, social and functional. A general HRQOL questionnaire (Psychological General Well Being Index -PGWBI-) and a visual analogue scale (VAS) of HRQOL were also administered to CD patients. RESULTS: Analysis of variance showed that both operated and non-operated CD patients scored lower, indicating a poorer HRQOL, than controls in global IBDQ and all five dimensions. However, neither global score, digestive and systemic symptoms, emotional and functional dimensions differed significantly between operated and nonoperated CD patients. PGWBI and VAS were also similar in both groups of CD patients (101 [93-106] vs 104 [97-107] and 85 [71-85] vs 80 [75-84] respectively). Only the social dimension of IBDQ was scored lower by operated vs non-operated CD patients (6.2 [4.8-6.8] vs 6.5 [4.3-7.0], p=0.01). In conclusion, although CD impairs the HRQOL, as compared to healthy controls, surgical treatment of CD patients does not worsen their HRQOL except in social dimension.