The influence of clinical and patient-reported outcomes (Proms) on post-surgery satisfaction in cholecystectomy patients

Abstract

Aims: Cholecystectomy is one of the most frequent procedures in the UK. Patient reported outcomes (PROMs) and post-operative satisfaction have become a growing focus of surgical outcome evaluation, and are considered key components of the movement towards patient-centred care in the NHS. The aim was to determine the relationship of post-surgery satisfaction with clinical outcomes and PROMs in cholecystectomy patients. Methods: Patients who had undergone elective or emergency cholecystectomy for gallstone disease were sent validated general and condition-specific PROM questionnaires (EQ-5D-5L, Otago gallstones CSQ). Telephone follow-up was performed in all cases. Those with gallbladder cancer or undergoing a concurrent procedure were excluded. Categorical data were compared with chi-squares, Fisher's exact, and Spearman's rho tests. Ordinal multivariate logistic regression analysis was performed for factors significantly (p < 0.05) associated with satisfaction in univariate analyses. Results: 234 adult patients underwent cholecystectomy between 1st March and 1st May 2014 and 147 patients (62.8%) completed the questionnaire. 141/147 (96%) reported being «satisfied» or «very satisfied» with the outcome of surgery. Satisfaction showed significant association with an absence of 30-day complications (p < 0.05, x2 test), but not re-attendance, readmission, or length of stay. PROMs associated with high satisfaction included the presence of substantial pre-operative dietary alteration (p < 0.05, x2 test), and absent post-operative wound pain or recurrent symptoms (p < 0.05, x2 test). Multiple regression analysis revealed that being able to undertake leisure activities was the sole clinical or PROM factor independently associated with patient satisfaction (OR = 1.84, 95% CI 1.19–2.87, p < 0.05). Conclusions: The majority of patient reported satisfaction post-cholecystectomy. Determining PROMs provides depth in understanding post-operative recovery, and were identified as important considerations alongside clinical outcomes, with return to normal life most associated with patient satisfaction. This also highlights a potential need for further pre-operative dietary advice in elective cholecystectomy and ensuring adequate post-operative analgesia to improve patient satisfaction.