Abdominal Surgery Impact Scale (Asis) Is Responsive in Assessing Outcome Following Ipaa
Indraneel Datta*1, Brenda I. O'Connor1, J Charles Victor3, Robin S. Mcleod2,4
1Dr. Zane Cohen Digestive Diseases Clinical Research Center, Toronto, ON, Canada; 2Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada; 3Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; 4Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, AB, Canada
Purpose: Various generic and disease specific quality of life instruments are available to assess outcome following surgery. However, they are not sensitive to assess outcome in the early postoperative period, which is important when assessing changes in postoperative care. Thus the aim of this study was to evaluate the responsiveness of the Abdominal Surgery Impact Scale (ASIS) in assessing quality of life in a cohort of patients undergoing ileal pouch-anal anastomosis (IPAA).
Methods: All patients over the age of 18 undergoing IPAA between March 2005 and October 2007 completed the ASIS on postoperative day 2 or 3 and at time of discharge. The ASIS consists of 6 domains and 18 items with scores ranging from 18 to 126. In addition, demographic, clinical and surgical data was collected including gender, age, steroids, laparoscopic assisted versus conventional surgery, ileostomy diversion, anastomotic leaks and small bowel obstructions. Length of stay data was also analyzed. Internal reliability of the ASIS was measured using Cronbach’s alpha coefficients.
Results: 92 patients (36 female, 56 male, mean age=36.83+/-10.79) completed the ASIS at the 2 time intervals (mean 3 days and mean 7 days postoperatively). 47 patients had an IPAA performed with an ileostomy; 11 patients had he IPAA performed laparoscopically. The mean hospital stay was 10.78 days. The overall mean ASIS score significantly increased over time (mean 56.93+/-18.3 vs. 81.83+/-17.27, p<0.001). Patients who had an ileostomy had a significantly lower mean score at discharge (77.32 vs. 86.82), secondary to lower scores on the physical limitations, functional impairment and visceral function domains. Seven patients (7.6%) had ileo-anal anastomotic leaks and seven patients (7.6%) had small bowel obstructions. Both leaks and bowel obstructions resulted in increased length of stay. Laparoscopic patients had a significantly lower length of stay (8.8 days vs. 11.1 days). Cronbach’s alpha coefficient was 0.94 overall and ranged from 0.69 to 0.91 for subscales indicating internal reliability.
Conclusions: ASIS is a reliable instrument for measure quality of life in the postoperative period and is responsive to changes over time. Although quality of life increases postoperatively during hospital stay, at discharge, patients with IPAA still have decreased quality of life. Patients with ileostomies have further decreased scores.
