|
Back to 2016 Annual Meeting
How Much Pain Relief Do Patients Expect After Cholecystectomy?
Alejandro L. Suarez*1, Onur Kutlu2, Steven C. Cunningham3, Juliane Bingener4, Katherine A. Morgan2, Peter B. Cotton1
1Department of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, SC; 2Department of Surgery, Medical University of South Carolina, Charleston, SC; 3Department of Surgery, St Agnes Hospital, Baltimore, MD; 4Department of Surgery, Mayo Clinic, Rochester, MN
Background: The number of cholecystectomies performed annually in United States for functional gall bladder disorder (FGBD, also known as gallbladder dyskinesia) are increasing. The success rates are unclear, due to the poor quality of reported data. In preparing a randomized controlled trial to redress this deficiency, we sought to understand how patients define success before they undergo cholecystectomy.
Aim: To identify the minimum level of pain reduction that patients would require to consider their surgery to be successful, and to compare the results between patients with and without stones.
Patients and Methods: The study was conducted at three tertiary medical centers from 2014-2015. Adult patients scheduled for a cholecystectomy with or without cholelithiasis and with >3 months of abdominal pain were enrolled. A written patient survey was administered, asking demographics and details of their pain, captured by a validated RAPID (Recurrent Abdominal Pain Intensity and Disability) score. The score quantitates the productivity lost in the prior 90 days due to pain within 3 domains: paid work or school, household work, and non-work social activities), the maximum score being 270, and questions about their expectations for success.
Results: The survey was completed by 109 patients, with an average age of 48 years (range 19-84; SD 15). Of these, 81 (74%) were female and 82 (76%) had stones, while 27 (25%) had no stones. Patients with and without stones reported similar mean durations, frequency and levels of pain. The baseline RAPID score for those with no stones was 37 (range 0-155; SD 43) compared with 26 (range 0-165; SD 38; P=.301) for those with stones. Those without stones reported that they would be satisfied with a higher RAPID score of 7 (range 0-50; SD 14) after cholecystectomy compared with those with stones who required a score of 2 (range 0-58; SD 7) (P= .018). Approximately 58% of patients with stones and 60% with no stones stated that they would be satisfied even if their pains were not completely relieved after surgery (Figure 1).
Conclusion: Most patients do not expect cholecystectomy to relieve their pain completely, and those without stones appear to be satisfied with less benefit than those with stones. These data are useful in the counsel of future patients, and will inform the design of a large trial.
 Figure 1. Survey results of pain improvement required for a successful surgery.
Back to 2016 Annual Meeting
|
