Abstracts 1998 Digestive Disease Week
#1049
WHAT MAKES FOR A SATISFIED PATIENT THREE MONTHS AFTER CHOLECYSTECTOMY? AN OUTCOME ANALYSIS OF 1325 PATIENTS. L. W. Traverso, R. Lonborg, L. F. Fenster, Virginia Mason Clinic, Seattle, WA.
The advent of laparoscopic techniques has resulted in an increased incidence of cholecystectomy, resulting in a need to reevaluate utilization. The new outcomes research movement emphasizes patient-derived data as well as traditional clinical outcomes. One of the purposes of this prospective observational study of 1325 patients was to seek possible correlations between a variety of variables--some of which are patient-derived--and the patients' degree of overall satisfaction with the outcome, as assessed by questionnaire three months after surgery, a time when the placebo effect is over. Methods: From July 1992 to May 1997, five different data collection forms were devised and implemented: 3 MD-derived sets of data, completed at the preop, intraop, and postop (via mail). In the postop instrument, patients were asked to rate their degree of satisfaction with the outcome of their surgery on a 1 to 5 scale, 5 being "extremely satisfied" and 1 being "not at all satisfied." We then sought differences between those patients rating their satisfaction as 5 versus those rating their satisfaction as 1 to 3. Because of our modification of selected questions over the 5-year period of this study and variable response rates for different data elements, the N for different rates are inconsistent. Results: Age, gender, and the presence of comorbidities did not correlate with eventual satisfaction with outcome. The following were correlated with a statistically significant better degree of satisfaction: the presence of known gallstones preoperatively (N=445), p=.012) or a history of typical biliary type pain as assessed by the surgeon preop (N=445, p=0.008); 93% of patients with both known stones and typical pain ended up very satisfied, compared to only 68% of those with neither typical pain nor known stones. The presence of complications--early or late--correlated with less satisfaction, but the difference was not significant (p=.18). The continued presence of abdominal pain postoperatively predicted dissatisfaction (N=543, p=.000)! Conclusion: Not surprisingly, continued problems with abdominal pain was strongly correlated with dissatisfaction, but this finding supported the accuracy of our assessment instrument and the following: the more typical and clear-cut the clinical presentation, the greater patient satisfaction with the outcome of cholecystectomy. When symptoms were less classic, and/or stones not documented preoperatively, patient satisfaction was significantly less. Once gallstones have been documented preoperatively, a good clinical history is the best manner to ensure superb utilization rather than a plethora of additional investigations.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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