Patient-perceived health-related quality of life before and after laparoscopic aortobifemoral bypass

Abstract

BackgroundIn patients operated with laparoscopic aortobifemoral bypass (LABFB) for atherosclerotic obstruction in aortoiliac segment, the main focus of the reports published during the last two decades has been morbidity and mortality. The primary objective of this study was to examine the health-related quality of life (HRQL) in these patients before and after LABFB.Patients and methodsFifty consecutive patients (27 females) with Trans-Atlantic Inter-Society Consensus II, type D lesions were prospectively included. Short-Form 36 (SF-36) questionnaire was used to get information about the HRQL before LABFB and at 1, 3 and 6 months after the operation. Main indication for LABFB was intermittent claudication. Linear mixed-effect models were used to assess changes in HRQL over time. Age, gender, smoking, blood loss, operation time, concomitant operation, the American Society of Anesthesiologists category, length of hospital stay, previous vascular procedures and aorta cross-clamping were used as fixed factors and their impact on the physical components of the SF-36, as well as the summary scores were determined with univariate analysis. Variables with P<0.2 were included in the multivariate regression analysis. P<0.05 was considered statistically significant.ResultsStatistically significant improvement was found in all SF-36 domains as well as in the summary scores after LABFB compared to the preoperative scores. The improvement in scores was substantial already at 1 month and the effect was maintained at 3 and 6 months survey time points. Concomitant operations had a statistically significant negative impact on the physical components of SF-36. Data completeness of item questionnaires was 93% in the whole material. Reliability scale and homogeneity estimates for the eight domains had high internal consistency.ConclusionPatients operated with LABFB for Trans-Atlantic Inter-Society Consensus II, type D lesions have reduced HRQL. LABFB leads to substantial and statistically significant improvement in the patients’ HRQL, when examined with SF-36. These results need to be replicated by a randomized clinical trial.

Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

“…In other patient groups, it has been shown that the benefits of laparoscopic surgery are mostly gained during the first year, 38 , 43 , 44 In our pilot study, the main effect on HRQoL was during the first 6 months. 14 Even if the difference between the 2 groups would later during follow-up decrease, there is no indication that the benefits in terms of HRQoL and spared economic costs will be in favor of other than LABF. There also seem to be no negative long-term effects of LABF for AIOD.…”

“…Based on our cohort study, we expected a gain in HRQoL during the first 6 months and similar results in the 2 groups thereafter. 13 , 14 The patients answered the EuroQol EQ-5D-5L questionnaire at 4 different time points; before surgery (baseline), and at 1, 3 and 6 months postoperatively. 30 , 31 The costs included in this study are the cost of surgical equipment, prosthesis and the costs related to the hospital stay.…”

“…The laparoscopic aortobifemoral bypass (LABF) has become an established treatment option for symptomatic AIOD at many dedicated centers. 6 – 11 At Oslo University Hospital, we introduced the laparoscopic technique in 2005, 12 – 14 and since February 2013, we have been conducting a randomized controlled trial, 15 , 16 to compare the early morbidity after the two treatment methods.…”

Health-related quality of life and determinants in North-China urban community residents

“…The MOS 36-item short form health survey (SF-36) has been used world-wide as a generic and coherent measure to assess HRQoL in patients and residents [ 8 – 10 ]. More than 40 translated versions have been applied around the world [ 11 ] and it is the standard for international quality of life assessment.…”