Health‐related quality of life after restorative proctocolectomy for ulcerative colitis: Long‐term results

Abstract

Restorative proctocolectomy (RPC) is the favorite operation for ulcerative colitis, but it may influence health-related quality of life (HRQL). Our aims were to determine the long-term HRQL of patients and its modifications after a 5-year follow-up and to identify any risk factor for a worse outcome. We enrolled 36 patients submitted to RPC (mean follow-up 8.4 +/- 4.7 years), 36 ulcerative colitis (UC) patients, and 36 healthy subjects. We used a previously validated questionnaire that explored bowel symptoms, systemic symptoms, emotional function, and social function. A series of 17 patients had completed the same questionnaire 5 years earlier. Clinical and surgical factors were investigated. Statistical analysis was performed with Student's t-test, Wilcoxon matched-pairs test, and Fisher's exact test. The scores of the RPC patients were significantly better than those of moderate or severe UC patients, similar to those with remission/mild UC, and higher than those of the controls. The scores of patients interviewed 5 years earlier did not change in the present study, except for patients during the first postoperative year, in whom the scores were now significantly better. The analysis of RPC patients in subgroups showed that the use of drugs, high stool frequency, pouchitis, pelvic complications, and younger age at UC diagnosis worsened the HRQL outcome. We concluded that RPC patients, after a long-term follow-up, had an HRQL similar to that of the remission/mild UC patients. Recently operated patients improved their quality of life mainly because of improved emotional function, and patients who had been operated on for a longer time maintained their HRQL. HRQL is influenced by drugs, stool frequency, pouchitis, postoperative pelvic complications, and age at diagnosis.

Psychological treatment may reduce the need for healthcare in patients with Crohnʼs disease

“…Healthcare utilization should be included in future therapy studies, especially those on high-utilizing CD patients with psychiatric comorbidity and after surgical interventions. 45 …”

“…One exclusion criterion, 279; age Ͼ 55 years, 8; refusal, 31; no acute attack within 2 years, 48; no acute attack after resection, 33; operation envisaged, 14; immunosuppressive therapy, 12; no specification, 12; ileostomy or colostomy, 6; other severe diseases, 6; wish for psychotherapy, 25; refusal of psychotherapy, 12; ongoing psychotherapy, 13; earlier psychotherapy, 14; other reasons, 45. Combination of two of these exclusion criteria, 85.…”

Rod in loop ileostomy: just an insignificant detail for ileostomy-related complications?

“…The differing assistance required by the patients in the two groups not only reflects on mere costs, as we demonstrated above, but also, possibly, on quality of life. In a previous paper, we demonstrated that in the long-term follow up, the quality of life of patients submitted to restorative proctocolectomy is negatively influenced by the need for medication and access to medical facilities [15]. In our opinion, the period immediately after restorative proctocolectomy, while the patient still has a temporary ileostomy, is even more delicate, and having a safe postoperative course free from any complication and with low requirement for medical care may be of crucial importance [22].…”

“…On the other hand, there are several "minor" complications such as pressure ulcers due to the rod pressure or peristomal dermatitis that are usually managed by the stoma therapist and that virtually never or rarely arrive to the attention of the surgeon. Nevertheless, such "minor" complications need extra medical care that may significantly affect the quality of life of the patients who were submitted to a restorative proctocolectomy [14,15] and may significantly increase the management costs of the procedure.…”

Lífsgæði eftir ristilbrottnám vegna sáraristilbólgu

“…Þónokkrar rannsóknir hafa metið lífsgaeði sjúklinga sem hafa þurft að fara í ristilbrottnám vegna sáraristilbólgu. 13,14,16,19,21,[25][26][27][28][29][30][31] Mun fleiri rannsóknir fjalla um sjúklingahóp með innri garnapoka en garnarauf. Rannsókn Camilleri-Brennan á meðal sjúklinga með garnarauf sýndi fram á lífsgaeði sambaerileg og meðal almennings.…”