Perioperative Quality Of Life Research Articles

Impact of Cross-Linking Procedure on Perioperative Quality of Life in Keratoconus Patients.

To evaluate the effect of crosslinking (CXL) with riboflavin for keratoconus (KC) therapy on quality of life (QoL): comparison of keratoconus patients with and without treatment. Prospective monocentric study. We recruited patients with progressive KC and with stable disease. Patients with progressive disease received cross-linking treatment; patients with stable disease were monitored. We compared QoL in both groups over 6 months and detected the influence of cross-linking treatment on QoL. QoL was assessed by NEI-VFQ-25, EQ-5D 5L, and EQ-Visual analog scale (VAS). In the evaluation of the Nei VFQ, the subgroups LFVFS and LFSES were calculated. We enrolled 31 eyes of 31 patients in the intervention group and 37 eyes of 37 patients in the control group. Medians with standard deviations (SD) were calculated. All QoL-tests showed equal scores at baseline in both groups. At V2, one day after the treatment, EQ-VAS (56.4), LFVFS (57.4), and EQ5D5L (0.59) were significantly reduced. At V3 (one week after treatment), all results returned to baseline level. LFSES was not affected by the treatment. It remained stable (V2 85.4, V3 84.3). Comparing the baseline scores with the follow-up scores at month 6, we found a significant increase in QoL in all tests in the intervention group. Otherwise, the quality of life in the control group did not change over time. Cross-linking led only to a short-term reduction in QoL. Although the treatment is painful for a few days, no effect on general quality of life LVSES has been demonstrated. QoL already returned to baseline after one week and the patients were not limited anymore.

Clinical comparison of percutaneous transforaminal endoscopic discectomy and unilateral biportal endoscopic discectomy for single-level lumbar disc herniation.

To compare the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic discectomy (UBE) for the treatment of single-level lumbar disc herniation (LDH). From January 2020 to November 2021, 62 patients with single-level LDH were retrospectively reviewed. All patients underwent spinal surgeries at the Affiliated Hospital of Chengde Medical University and Beijing Tongren Hospital, Capital Medical University. Among them, 30 patients were treated with UBE, and 32 were treated with PTED. The patients were followed up for at least one year. Patient demographics and perioperative outcomes were reviewed before and after surgery. The Oswestry Disability Index (ODI), visual analog scale (VAS) for back pain and leg pain, and modified MacNab criteria were used to evaluate the clinical outcomes. x-ray examinations were performed one year after surgery to assess the stability of the lumbar spine. The mean ages in the UBE and PTED groups were 46.7 years and 48.0 years, respectively. Compared to the UBE group, the PTED group had better VAS scores for back pain at 1 and 7 days after surgery (3.06 ± 0.80 vs. 4.03 ± 0.81, P < 0.05; 2.81 ± 0.60 vs. 3.70 ± 0.79, P < 0.05). The UBE and PTED groups demonstrated significant improvements in the VAS score for leg pain and ODI score, and no significant differences were found between the groups at any time after the first month (P > 0.05). Although the good-to-excellent rate of the modified MacNab criteria in the UBE group was similar to that in the PTED group (86.7% vs. 87.5%, P > 0.05), PTED was advantageous in terms of the operation time, estimated blood loss, incision length, and length of postoperative hospital stay. Both UBE and PTED have favorable outcomes in patients with single-level LDH. However, PTED is superior to UBE in terms of short-term postoperative back pain relief and perioperative quality of life.

Quality of life and symptom distress after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/ HIPEC) for peritoneal surface malignancy can effectively control the disease, however it is also associated with adverse effects which may affect quality of life (QoL). To investigate early perioperative QoL after CRS/HIPEC, which has not been discussed in Taiwan. This single institution, observational cohort study enrolled patients who received CRS/HIPEC. We assessed QoL using the Taiwanese version of the MD Anderson Symptom Inventory (MDASI-T) and European Organization Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Participants completed the questionnaires before CRS/HIPEC (S1), at the first outpatient follow-up (S2), and 3 mo after CRS/HIPEC (S3). Fifty-eight patients were analyzed. There was no significant perioperative difference in global health status. Significant changes in physical and role functioning scores decreased at S2, and fatigue and pain scores increased at S2 but returned to baseline at S3. Multiple regression analysis showed that age and performance status were significantly correlated with QoL. In the MDASI-T questionnaire, distress/feeling upset and lack of appetite had the highest scores at S1, compared to fatigue and distress/feeling upset at S2, and fatigue and lack of appetite at S3. The leading interference items were working at S1 and S2 and activity at S3. MDASI-T scores were significantly negatively correlated with the EORTC QLQ-C30 results. QoL and symptom severity improved or returned to baseline in most categories within 3 mo after CRS/HIPEC. Our findings can help with preoperative consultation and perioperative care.

Comparison of Radiographic Parameters and Perioperative Quality of Life According to the Degree of Adenoid Extension to Choana

Background and Objectives The aims of this study were to clarify the impact of adenoidal extension toward the choana on the quality of life and to find differences in radiographic parameters between patients needing additional excision with a 90-degree tip and those who only require a 40-degree debrider tip.Subjects and Method Patients who underwent adenoidectomy with both 40-degree and 90-degree debrider tips were defined as the difficult-to-treat (DTT) group. Patients who underwent adenoidectomy using only a 40-degree debrider tip were defined as the control group. We measured the antroadenoidal distance, the adenoidal nasopharyngeal ratio (ANR), the length from the adenoid to hard palate, and reviewed the Korean Obstructive Sleep Apnea-18 (KOSA-18) scale scores.Results There was no difference in the quality of life due to OSA between the DTT and control groups, pre- and post-operatively. Correlation analysis between the antroadenoidal distance and the pre-operative KOSA-18 scale scores revealed a negative correlation. The antroadenoidal distance was shorter in the DTT group; however, a cut-off value could not be obtained. The ANR was a statistically discriminatory, but not effective, factor.Conclusion There was no difference in the KOSA-18 scale scores between the groups with the adenoidal extension toward the choana and the control. The ANR should be considered in the pre-operative radiographic evaluation but is not a diagnostic parameter for choanal extension. Further studies to find additional parameters are necessary.

Study protocol for a randomised, patient- and observer-blinded evaluation of P6 acustimulation for the prevention of nausea and vomiting in the postoperative period in patients receiving routine pharmacological prophylaxis (P6NV-Trial)

BackgroundThe efficacy of pericardium 6 (P6) acupoint stimulation to reduce the incidence of postoperative nausea and vomiting (PONV) has been proven in several randomised controlled clinical trials. However, little is known about the effectiveness in daily practice and its use in combination with traditional pharmacologic approaches.MethodsThe primary objective of the P6NV study is to determine whether intraoperative acustimulation (acupuncture or acupressure) at the point P6 provides additional benefit when applied along with customary prophylactic intravenous antiemetics administered according to the local standard operating procedures (SOP). The primary endpoint is the incidence and severity of PONV within the first 24 h postoperatively reported with a validated postoperative nausea and vomiting intensity scale. The patient-reported outcome of perioperative quality of life (using the PPP33-questionnaire) and the detection of antiemetic-related side effects as well as the severity of PONV (via a standardised questionnaire) are secondary study objectives. P6NV is a national, multicentre, randomised, prospective, patient- and examiner-blinded interventional study and will be performed on 3500 adult patients with ASA classification I–III undergoing elective surgery under general anaesthesia and hospitalised for at least 24 h. Participating anaesthesiologists commit themselves to administer customised conventional antiemetic prophylaxis according to the local SOP by signing a statement before randomisation. The intervention group receives bilateral acupuncture or acupressure at P6. The control group receives no intervention. Before extubation, acustimulation is removed.DiscussionSince P6 acustimulation is performed by a wide range of anaesthesiologists receiving written and verbal information on acustimulation beforehand, this trial will provide information on the effectiveness of an ad hoc implementation of P6 stimulation techniques in anaesthesia departments using traditional pharmacologic PONV prophylaxis.Trial registrationDRKS DRKS00015272. Registered on August 15, 2018.

Effects of Psychological Intervention on Perioperative Quality of Life and Serum PSA and FPSA Levels of Patients with Prostate Cancer Treated with Integrated Traditional Chinese and Western Medicine.

Objective To observe the effects of psychological intervention on the perioperative quality of life and serum prostate-specific antigen (PSA) and free PSA (FPSA) levels in patients with prostate cancer treated with integrated traditional Chinese and Western medicine. Method A total of 208 prostate cancer patients were selected and randomly divided into a study group with 104 cases and a control group with 104 cases. The control group received a plan of basic nursing combined with integrated traditional Chinese and Western medicine, and the study group received psychological intervention on the basis of the control group. Negative emotion, pain degree, quality of life, maximum urine flow rate, residual urine volume, International Prostate Symptom Score (IPSS), and incidence of adverse reactions were compared between the two groups before and after the treatment. The levels of PSA and FPSA and the long-term efficacy of the two groups of patients before and after treatment were compared. Results After nursing, Hamilton Anxiety Scale (HAMA) score, Hamilton Depression Scale (HAMD) score, pain degree, maximum urine flow rate, residual urine volume, IPSS score, emotional function, social function, role function, and physical function scores of patients in two groups were decreased, and the decrease was more significant in the study group. After treatment, serum PSA and FPSA levels in the study group were obviously lower than those in the control group. The two-year cumulative survival rate of the study group was higher than that of the control group. There was no significant difference in the cognitive function score and incidence of adverse reactions between the two groups. Conclusion Psychological intervention combined with traditional Chinese and Western medicine in the treatment of prostate cancer can effectively improve the patient's psychological state, reduce the degree of pain in patients, improve the therapeutic effect and the quality of life of patients, and significantly reduce serum PSA and FPSA levels, which could lead to a prolonged life.

Effect of Psychological Intervention Combined with Family Cooperation on the Perioperative Quality of Life and Psychological States of Elderly Patients with Prostate Cancer Treated with Compound Kushen Injection.

Objective The purpose of the study was to investigate the nursing effect of psychological intervention combined with family cooperation on elderly patients with prostate cancer treated with compound kushen injection and put forward effective suggestions. Methods 122 elderly patients with prostate cancer admitted to our hospital from June 2018 to June 2019 were selected and randomly divided into a control group (n = 61) and experimental group (n = 61). The patients in the control group received routine nursing intervention during the perioperative period, while the patients in the experimental group were treated with psychological intervention combined with family cooperation on the basis of routine nursing. The quality of life and psychological states of patients in the two groups were statistically analyzed. Results The evaluation of psychological states at 24 hours before surgery and 24 hours before discharge in the experimental group was significantly better than that in the control group (P < 0.05), with statistical significance. On comparing the basic conditions between the two groups in the perioperative period, the length of hospitalization, length of catheter retention after surgery, and incidence of complications in the experimental group were all significantly better than those in the control group (P < 0.05), with statistical significance. The satisfaction of patients with the nursing process in both groups was recorded and statistically analyzed through questionnaires. The satisfaction with nursing process in the experimental group was significantly higher than that in the control group (P < 0.05), with statistical significance. The quality of life of the patients was followed up at three months after discharge. The quality of life of the experimental group was significantly better than that of the control group (P < 0.05), with statistical significance. Conclusion Psychological intervention combined with family cooperation for the elderly patients with prostate cancer treated with compound kushen injection is beneficial to improve their psychological states, encourage them to face the disease in a more positive manner, effectively improve the quality of life after intervention, ensure the therapeutic effect during perioperative period, increase happiness index, and enhance their satisfaction with the nursing process, which is worthy of clinical application and popularization.

A comparison study of percutaneous endoscopic decompression and posterior decompressive laminectomy in the treatment of thoracic spinal stenosis

BackgroundPercutaneous endoscopic decompression (PED) is considered a minimally invasive and safe procedure in lumbar degenerative disease. Few authors report the success of PED for thoracic spinal stenosis (TSS) with thoracic myelopathy. The objective of this study was to compare the outcome of PED versus posterior decompressive laminectomy (PDL) for TSS.MethodsWe retrospectively reviewed 30 consecutive patients who underwent surgery for single-level TSS from January 1, 2015 to May 1, 2019.These patients were divided into PED (n = 16) and PDL(n = 14) group. Preoperative demographic characteristics and perioperative outcomes were reviewed. Pre- and postoperative neurological status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score and the recovery rate (RR).ResultsThe patients’ mean age was 57.3 years (27–76) in PED group and 58.8 years (34–77) in PDL group. No statistical difference was found between two groups with regards to neurological status at pre-operative and final follow-up. The RR in PED group achieved the same improvement as PDL group (87.5% vs 85.7%, P > 0.05), while the PED brought advantages in operative time(m) (86.4 vs 132.1, p < 0.05), blood loss (mL) (18.21 vs 228.57, p < 0.05),drainage volume(mL) (15.5 vs 601.4, p < 0.05), and hospital stay (d) (3.6 vs 5.6, p < 0.05).ConclusionsBoth PED and PDL showed favorable outcome in the treatment of TSS. Besides, PED had advantages in reducing traumatization. In terms of perioperative quality of life, PED could be an efficient supplement to traditional posterior decompressive laminectomy in patients with TSS.

Improved perioperative quality of life in endoscopic sinus surgery by application of enhanced recovery after surgery.

Background: Endoscopic sinus surgery (ESS) has been the definitive treatment for chronic rhinosinusitis (CRS), but the complications caused perioperatively may affect patients’ quality of life (QoL). This study aims to evaluate the effects of enhanced recovery after surgery (ERAS) on improving perioperative QoL in ESS.Materials and methods: Seventy-four patients with chronic rhinosinusitis with nasal polyps (CRSwNP) met the criteria for inclusion. Participants undergoing ESS were randomly divided into an ERAS group and a control group, and QoL assessment was performed using the Chinese version of the 22-item Sinonasal Outcomes Test (SNOT-22). Measurements were administered at baseline, and on postoperative day 1 (POD1), POD3 and POD6. Complications such as nausea/emesis, hemorrhage, aspiration and dizziness were also recorded.Results: The preoperative global SNOT-22 scores (mean ± SD) were 39.89±4.86 in the ERAS group and 40.52±3.61 in the control group (t=0.643, P=0.522). On POD1, the global SNOT-22 scores increased significantly to 51.77±5.59 and 62.02±3.86 (t=9.218, P<0.01), and on POD3 they increased to 48.22±6.22 and 51.11±5.14, respectively (t=2.179, P<0.05). However, the scores recovered to 39.39±4.73 and 40.13±3.31 in the respective groups on POD6, which were lower than but not statistically significant different from the baseline (t=0.786, P=0.434). There were statistically significant improvements across all subdomains of SNOT-22 for patients in the two groups only in POD1 (all P<0.05). The ERAS group did not have an increased incidence of complications such as nausea/emesis (χ2=0.223, P>0.05), hemorrhage, aspiration and dizziness compared to the control group.Conclusion: ERAS could improve perioperative QoL in patients with CRSwNP undergoing ESS, and SNOT-22 can be used for ERAS evaluation as a patients’ outcome report.

Brain atlas for assessing the impact of tumor location on perioperative quality of life in patients with high-grade glioma: A prospective population-based cohort study

BackgroundTumor location is important for surgical decision making. Particular attention is paid to regions that contain sensorimotor and language functions, but it is unknown if these are the most important regions from the patients' perspective.ObjectiveTo develop an atlas for depicting and assessing the potential importance of tumor location for perioperative health-related quality of life (HRQoL) in patients with newly diagnosed high-grade glioma.MethodsPatient-reported HRQoL data and semi-automatically segmented preoperative 3D MRI-images were combined in 170 patients. The images were registered to a standardized space where the individual tumors were given the values and color intensity of the corresponding HRQoL. Descriptive brain maps of HRQoL, defined quantitative analyses, and voxel-based lesion symptom mapping comparing patients with tumors in different locations were made.ResultsThere was no statistical difference in overall perioperative HRQoL between patients with tumors located in left or right hemisphere, between patients with tumors in different lobes, or between patients with tumors located in non-eloquent, near eloquent, or eloquent areas. Patients with tumors involving the internal capsule, and patients with preoperative motor symptoms and postoperative motor deficits, reported significantly worse overall HRQoL-scores.ConclusionsThe impact of anatomical tumor location on overall perioperative HRQoL seems less than frequently believed, and the distinction between critical and less critical brain regions seems more unclear according to the patients than perhaps when judged by physicians. However, worse HRQoL was found in patients with tumors in motor-related regions, indicating that these areas are crucial also from the patients' perspective.

Physiological and operative severity score for the enumeration of mortality and morbidity, frailty, and perioperative quality of life in the elderly.

Background:Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) is a validated instrument used to predict morbidity. The aim of our study was to evaluate the performance of the POSSUM score system on predicting perioperative frailty and quality of life (QOL) in elderly surgical patients.Patients and Methods:An observational prospective study was conducted during 3 months. POSSUM was used to determine operative morbidity risk. Patients with a POSSUM score ≥26 were considered as having a high POSSUM (PHP). WHODAS 2.0, EuroQOL-5 dimensions (EQ-5D), Charlson score, and the Clinical Frailty Scale were used to assess the QOL and frailty. Chi-square, Fisher's exact, or Mann–Whitney tests were used for comparisons.Results:Two hundred and thirty-five patients were included. Median age was 69 years; 58% were ASA I/II and 42% ASA III/IV. Frailty was present in 53 patients (23%). Median POSSUM score was 26. Patients PHP were older (median age 71 vs. 68, P = 0.008), more frequently ASA III/IV (P = 0.001), had higher median Charlson scores (7 vs. 5, P = 0.006) and were more frail (49% vs. 26%, P < 0.001). PHP presented more problems in EQ-5D dimensions preoperatively (mobility: 59% vs 41%, P = 0.008; care: 41% vs. 25%, P = 0.013; activity: 52% vs. 32%, P = 0.002; pain: 59% vs. 45%, P = 0.041) but not anxiety (P = 0.137). Three months after surgery, PHP patients presented more problems in mobility: 63% vs. 38%, P < 0.001; care: 48% vs. 31%, P = 0.009; activity: 58% vs. 44%, P = 0.036; pain 59% vs. 37%, P = 0.001 and anxiety: 54% vs. 50%, P = 0.025.Conclusions:Patients PHP were frailer and had worse perioperative QOL.

Comparison of standard percutaneous nephrolithotomy and tubeless percutaneous nephrolithotomy

Objective Using Wisconsin Stone Quality of Life questionnaire(WISQOL) to compare standard percutaneous nephrolithotomy(PCNL) and tubeless PCNL. Methods From January 2017 to June 2017, patients who met the criteria (no urinary tract infection, stones between 1-3 cm, hydronephrosis larger than 3cm, renal cortex thickness >2 cm and without serious heart, lung, liver and kidney dysfunction and coagulation dysfunction) and underwent PCNL were prospectively enrolled and randomized into 2 groups, standard PCNL group and tubeless PCNL group. Diclofenac sodium suppositories were used to relieve pain in all patients with obvious pain. The quality of life of these patients were estimated and compared by using WISQOL. Safety and efficacy were also estimated. Result At the end of the study, a total of 50 patients were included in the analysis. There were 24 patients in the standard PCNL group and 26 patients in the tubeless PCNL group. There were 9 male patients in the standard PCNL group and 17 male patients in the tubeless PCNL group. There was no significant difference in gender between the two groups. The differences between the standard PCNL group and tubeless PCNL group in mean age(yrs.)[(53.21±13.35)vs.(51.1±11.5), P=0.55], stone diameter(mm)[(18.46±5.58)vs.(18.75±5.39), P=0.85], stone-free rate(23/24 vs. 24/26, P=0.60), mean hemoglobin decline(g/L)[(11.87±9.20)vs. (10.43±8.49), P=0.56] were not significant. Mean dosage of acesodyne(pcs) in tubeless PCNL group (4.07±1.49)was significantly less than that in standard PCNL group(7.54±2.23). There were no patient need transfusion or postoperative fever management. The influence of perioperative quality of life of patients treated with tubeless PCNL is significantly better than those treated with standard PCNL in 16 items which includ energy, sleep, work and family, physical symptoms, concerns related to intimacy and travel, and general emotional well-being. Conclusion Tubeless PCNL can improve patients’ quality of life compared with standard PCNL. Key words: Percutaneous nephrolithotomy; Quality of life; Renal stone; Tubeless

Perioperative Quality of Life in Cushing's Disease.

Our study evaluated the perioperative quality of life (QoL) in Cushing's disease (CD) patients, along with correlations between patient variables and cure rate. The 36-item Short-Form Health Survey (SF)-36 questionnaire was used to assess perioperative QoL. Patients completed one survey preoperatively and two surveys postoperatively. Retrospective chart review was conducted to collect SF-36 data as well as examine variables including: age, hospital stay, size of tumour, pathological diagnosis, timing of cure, and complication rates. Statistical analysis was conducted on the scores reported by the SF-36, and were compared with the normal Canadian population values, and to a sample of QoL from nonfunctioning pituitary tumour patients. This project was approved by University of British Columbia Research Ethics Board #H15-01572. In general, CD patients have relatively poor QoL that does improve as expected when cured, but not quite to normal levels. Factors associated with cure included presence of macroadenoma, confirmatory pathology, and patient age. Postoperative timing of cure appears to affect the durability of cure, with an immediate cure having a higher durability rate than delayed cure. Most recurrences occurred within 10 months postoperatively. This review of the perioperative QoL in CD helps to illustrate how QoL changes throughout the treatment process, how QoL compares to normal Canadian population levels, and how QoL compares to patients with nonfunctioning pituitary adenomas. As treatment outcome has such a high impact on QoL, the variables identified in this study will help to better inform patients about the treatment course.

The impact of vascular surgery wound complications on quality of life

ObjectiveIn addition to traditional surgical outcomes, perioperative quality of life is being scrutinized as a patient-centric metric. As part of a prospective study in a contemporary surgical cohort, subjective health states were examined in context of postoperative wound complications (WCs). We hypothesized that WCs negatively affect quality of life. MethodsThe EuroQol (EQ)-5D subjective health state data, comprising five domains with 1 (good) to 3 (poor) ordinal scoring, plus visual analog score, were collected at the day of surgery and at 2 and 4 weeks of follow-up in a study evaluating silver-eluting dressings in 500 patients at three centers. A preference-weighted index was calculated. Groups were defined by no complication (NC) or presence of one or more postoperative WCs. ResultsPatients (72% male) were a mean age of 67.6 years. Primary indications included critical limb ischemia (41.4%), claudication (31.6%), and abdominal aortic aneurysm (11.2%; open groin access for endovascular aneurysm repair). At least one WC occurred in 148 patients (29.6%). Baseline demographics were similar except mean age (NC group, 67.9 years; WC group, 65.7 years; P = .042) and body mass index (NC group, 27.0 kg/m2; WC group, 28.2 kg/m2). WCs were associated with use of conduit for reconstruction (P = .002), below-knee incisions (P = .002), and incision length (P < .001). Compared with the NC group, there was a decrement in quality-of-life scores in the WC group at 2 weeks (mean change, −0.217; P = .001) but not at 4 weeks (mean change, +0.044; P = .065) postoperatively. Subgroup analysis showed quality-of-life change after WC was most significant in the claudication group (P = .008). The EQ-5D visual analog scale score was lowest in groups with rest pain (57.0) and tissue loss (55.1) and highest in the abdominal aortic aneurysm cohort (71.8). ConclusionsEQ-5D identified a significantly decreased quality-of-life score 2 weeks after WCs in a cohort undergoing elective infrainguinal arterial surgery. This effect was not present 4 weeks postoperatively.

Perioperative quality of life in functionally dependent glioblastoma patients: A prospective study

Objective. Functionally dependent patients with glioblastoma have a poor prognosis which may in part be due to a negative treatment selection. Prospective data on patient-reported quality of life (QoL) following surgery, together with an updated survival analysis, are lacking with regard to functionally dependent glioblastoma patients. Materials and methods. Adult patients (≥ 18 years) with a histologically confirmed primary glioblastoma with preoperative Karnofsky Performance Status (KPS) ≤ 60, who were treated between January 1, 2007 and March 30, 2014, were eligible for inclusion. EuroQol 5D (EQ-5D) was scored before surgery and at 4–6 weeks postoperatively. A control group of 20 independent (i.e., KPS ≥ 70) adult primary glioblastoma patients was constructed. Results. Among the 27 patients included, only 22 patients were willing to participate in QoL research, with complete QoL follow-up data obtained for 16. There were 22 resections and 5 biopsies. In resection cases, the median extent of resection was 93% (IQR 78–99), with gross-total resection achieved in 24%. In the 16 patients with complete QoL data, the EQ-5D index score increased from 0.34 ± 0.38 preoperatively to 0.45 ± 0.32 postoperatively (p = 0.30), with 3 patients that deteriorated in QoL following surgery. Median survival was 7.3 months (95%, CI: 4.6–9.9, n = 27), and the perioperative mortality was 7%. Treatment characteristics between dependent and independent patients were similar, as were the unfavorable outcomes defined as QoL reduction, QoL drop-out, and dead before QoL assessment (41% vs. 45%, p = 0.79). However, a difference was seen in 6-month survival (42% vs. 15%, p = 0.05). Conclusion. In most functionally dependent patients with glioblastoma, cytoreductive surgery is possible, and improved or unchanged postoperative QoL may be seen in approximately half of the cases. This must be weighed against the risk of complications and the modest effect of cytoreductive surgery.

PC56. The Impact of Vascular Surgery Wound Complications on Quality of Life

In addition to traditional surgical outcomes, perioperative quality of life (QoL) is being scrutinized as a patient-centric metric. As part of a prospective study in a contemporary surgical cohort, subjective health states were examined in the context of postoperative wound complications. We hypothesized that wound complications negatively impact QoL. EQ-5D subjective health state data, comprising five domains with 1 to 3 ordinal scoring (1 = good, 3 = poor), plus analog score, were collected at the day of surgery, and at 2 and 4 weeks’ follow-up (FU) in a study evaluating silver-eluting dressings in 500 patients at three centers. Groups were defined based on absence (NC) or presence (WC) of one or more postoperative wound complications. Mean patient age was 67.6; 72.2% were male. Primary indications included critical limb ischemia (41.4%), claudication (31.6%), and abdominal aortic aneurysm (11.2%; open groin access for endovascular repair). At least one WC occurred in 148 patients (29.6%). A total of 774 of 929 (83.3%) of FU visits included EQ-5D data in all six dimensions. There was no difference in the WC/NC groups in three basic demographic, eight laboratory, and eight medical history variables (P > .05 for all). Among seven recorded surgical indications, mean analog heath state scores were lowest in the tissue loss group (55.1) and highest in the AAA group (71.9; analysis of variance P < .001). Although mean overall baseline and FU health analog scores were not different in the WC (66.8) and NC (67.8) groups (P = .44); mobility (P < .001), self-care (P = .01); usual activities (P = .03), and pain (P < .001) scores demonstrated increased disability in the WC group (Table). Intensive care unit length of stay, and discharge to rehabilitation, nursing home, or hospice was associated with lower mean analog health score (P < .001 for both). Postoperative lower extremity wound complications result in short-term QoL decrements in several domains, highlighting the patient-centric morbidity of these complications beyond their health and economic impacts.TableEQ-5D DomainGroupBaseline2 weeks FU4 weeks FUPMobilityNC1.901.691.59<.001WC1.911.841.75Self-careNC1.171.251.16.01WC1.161.361.26Usual ActivitiesNC1.641.801.66.03WC1.661.961.76Pain-discomfortNC1.911.681.63<.001WC2.001.871.82Anxiety-depressionNC1.401.301.26.38WC1.391.381.31Analog Health StateNC62.569.169.4.44WC61.468.068.7FU, Follow-up; NC, no wound complication; WC, wound complication. Open table in a new tab

Use of Urostomy Bags in the Management of Perioperative Urine Leakage After Radical Cystectomy

Urine leakage is a common complication in patients with bladder cancer after radical cystectomy and neobladder reconstruction. The aim of this study was to evaluate the clinical value of the use of urostomy bags in the management of urine leakage in patients with bladder cancer after radical cystectomy. Urine leakage during the perioperative period was retrospectively analyzed in 483 patients with bladder cancer who underwent radical cystectomy from 2004 to 2010. Before 2008, all patients with urine leakages were treated by routine dressing changes (group A). After 2008, the leakages were managed with urostomy bags (group B). The perioperative quality of life (EQ-5D) and cost for urine leakage for both groups were compared in this controlled study. The average cost in management of preoperative urine leakage was significantly higher in group A than in group B as well as the patients with extravasations of urine or lymphoceles. Patients in group B had an overall better perioperative life quality compared with group A. In particular, the score for pain/discomfort was significantly higher in group A than in group B. The management of perioperative urine leakage with urostomy bags avoided constant body wetness and significantly increased the quality of life and reduced the special costs of urine leakage in patients with bladder cancer after cystectomy. Early use of urostomy bag is a good choice for perioperative urine leakage in patients with bladder cancer after radical cystectomy and neobladder reconstruction.

Median arcuate ligament syndrome in the pediatric population

ObjectivesMedian arcuate ligament syndrome (MALS) is a vascular compression syndrome with symptoms that overlap chronic functional abdominal pain (CFAP). We report our experience treating MALS in a pediatric cohort previously diagnosed with CFAP. Patients and MethodsWe prospectively evaluated 46 pediatric (<21years of age) patients diagnosed with MALS at a tertiary care referral center from 2008 to 2012. All patients had previously been diagnosed with CFAP. Patients were evaluated for celiac artery compression by duplex ultrasound and diagnosis was confirmed by computed tomography. Quality of life (QOL) was determined by pre- and postsurgical administration of PedsQL™ questionnaire. The patients underwent laparoscopic release of the median arcuate ligament overlying the celiac artery which included surgical neurolysis. We examined the hemodynamic changes in parameters of the celiac artery and perioperative QOL outcomes to determine correlation. ResultsAll patients had studies suggestive of MALS on duplex and computed tomography; 91% (n=42) positive for MALS were females. All patients underwent a technically satisfactory laparoscopic surgical release resulting in a significant improvement in blood flow through the celiac artery. There were no deaths and a total of 9 complications, 8 requiring a secondary procedure; 33 patients were administered QOL surveys. 18 patients completed the survey with 15 (83%) patients reporting overall improvement in the QOL. Overall, 31/46 patients (67%) reported improvement of symptoms since the time of surgery. ConclusionsMALS was found to be more common in pediatric females than males. Laparoscopic release of the celiac artery can be performed safely in the pediatric population. Surgical release of the artery and resultant neurolysis resulted in significant improvement in the blood flow, symptoms, and overall QOL in this cohort. The overall improvement in QOL outcome measures after surgery leads us to conclude that MALS might be earlier diagnosed and possibly treated in patients with CFAP. We recommend a multidisciplinary team approach to care for these complex patients.

Responsiveness of quality of life instruments for the comparison of minimally invasive cholecystectomy procedures

Traditional metrics of postoperative outcomes (morbidity and mortality) are not useful to compare minimally invasive procedures with each other. Patient reported outcomes, such as quality of life (QOL) scores, offer an alternative approach. Compared with a large body of data in cancer treatment, the responsiveness of these instruments for minimally invasive surgery is not well described. To better define expected differences, we analyzed the reported QOL outcomes in randomized, controlled trials (RCTs) comparing single and four-port laparoscopic cholecystectomy. Searching Medline, Embase, Psychinfo, Scopus, and the Cochrane Library (1946 to Jan 2012), two independent reviewers identified RCTs comparing single with four-port cholecystectomy in adult patients using perioperative QOL assessments. The quality of the studies was assessed regarding trial design and QOL reporting. RevMan was used for mathematical analysis of the pooled outcome data using a random-effects model. Standardized mean difference estimation was utilized when pooling studies reporting different QOL tools. Statistical heterogeneity was assessed using χ(2) and I(2). Of 743 citations, 37 RCTs were identified. Five studies with a total of 502 patients compared single with four-port cholecystectomy on QOL and were included. Pooled analysis was performed using preoperative and 1-month postoperative outcomes. At 1 month postoperatively, the reported effect size of perioperative QOL changes was up to 5 points (~1/2 SD) on the global SF 12 score. The largest difference in change of perioperative physical functioning was 9.9 points (~1 SD). No difference between the treatments was demonstrated. Reporting of QOL may improve the comparison of minimally invasive surgical procedures. This systematic review reports clinically important changes and did not demonstrate a difference between treatments at 1 month postoperatively. The optimal timing and trial design for QOL tools in this setting needs to be defined further.

Evaluation of the application effect of evidence-based nursing model in improvement of preoperative fears and perioperative quality of life for patients undergoing general surgery

Objective To observe the effect of evidence-based nursing on improvement of preoperative fears and perioperative quality of life in patients undergoing general surgery. Methods 160 cases of general surgery patients in our hospital from September 2009 to September 2010 were chosen as the research object.The 160 cases were divided into the control group and the observation group with 80 cases in each group.The control group was taken with perioperative routine care.The observation group was given evidence-based nursing.The preoperative fear score (FAVS),perioperative quality of life (QOL)score and treatment compliance for the two groups were compared. Results The fear scores for the two groups of patients before treatment were compared.The score in the observation group was significantly lower than the control group,the difference was significant.The scores of preoperative and postnperative quality of life for the two groups were compared.The patients of the observation group were significantly higher than the patients of the control group,the difference between the two groups was significant.The treatment compliance of the observation group was better than that of the control group. Conclusions The evidence- based nursing model can improve preoperative fears and perioperative quality of Wife of patients undergoing general surgery,improve patients' treatment compliance,and promote the success of operation and recovery of patients.It is worthy of clinical application. Key words: Evidence-based nursing; General surgery; Preoperative fears; Quality of life; Treatment compliance