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Patient Perceptions and Quality of Life After Colon and Rectal Surgery: What Do Patients Really Want?

Wrenn, Sean M., M.D.1; Cepeda-Benito, Antonio, Ph.D.2; Ramos-Valadez, Diego I., M.D.3; Cataldo, Peter A., M.D.1

Diseases of the Colon & Rectum: August 2018 - Volume 61 - Issue 8 - p 971–978
doi: 10.1097/DCR.0000000000001078
Original Contributions: Quality of Life
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BACKGROUND: Colorectal surgery outcomes must be accurately assessed and aligned with patient priorities. No study to date has investigated the patient’s subjective assessment of outcomes most important to them during and following their surgical recovery. Although surgeons greatly value the benefits of laparoscopy, patient priorities remain understudied.

OBJECTIVE: This study aimed to assess what aspects of patients’ perioperative care and recovery they value most when queried in the postoperative period.

DESIGN: This study is an exploratory cross-sectional investigation of a defined retrospective patient population. Enrollees were stratified into subcategories and analyzed, with statistical analysis performed via χ2 test and unpaired t test.

SETTINGS: This study was conducted at a single academic medical center in New England.

PATIENTS: Patients who underwent a colorectal surgical resection between 2009 and 2015 were selected.

INTERVENTIONS: Patients within a preidentified population were asked to voluntarily complete a 32-item questionnaire regarding their surgical care.

MAIN OUTCOME MEASURES: The primary outcomes measured were patient perioperative and postoperative quality of life and satisfaction on selected areas of functioning.

RESULTS: Of 167 queried respondents, 92.2% were satisfied with their recovery. Factors considered most important included being cured of colorectal cancer (76%), not having a permanent stoma (78%), and avoiding complications (74%). Least important included length of stay (13%), utilization of laparoscopy (14%), and incision appearance and length (2%, 4%).

LIMITATIONS: The study had a relatively low response rate, the study is susceptible to responder’s bias, and there is temporal variability from surgery to questionnaire within the patient population.

CONCLUSIONS: Overall, patients reported high satisfaction with their care. Most important priorities included being free of cancer, stoma, and surgical complications. In contrast, outcomes traditionally important to surgeons such as laparoscopy, incision appearance, and length of stay were deemed less important. This research helps elucidate the outcomes patients truly consider valuable, and surgeons should focus on these outcomes when making surgical decisions. See Video Abstract at http://links.lww.com/DCR/A596. See Visual Abstract at https://tinyurl.com/yb25xl66.

1 Department of Surgery, Robert Larner M.D. College of Medicine, Burlington, Vermont

2 Department of Psychological Science, University of Vermont, Burlington, Vermont

3 Sanford Health, Thief River Falls, Minnesota

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: This research was funded by the University of Vermont Department of Surgery. There were no external funding sources.

Financial Disclosures: None reported.

Presented at the meeting of the Academic Surgical Congress, Las Vegas, NV, February 7 to 9, 2017; at the meeting of the New England Society for Colon and Rectal Surgery, York, ME, May 20 to 21, 2017; and at the meeting of the Vermont Chapter of the American College of Surgeons, Burlington, VT, June 8, 2017.

Correspondence: Sean Wrenn, MD, UVM Department of Surgery, 111 Colchester Ave, Burlington, VT 05401. E-mail: Sean.Wrenn@uvmhealth.org

© 2018 The American Society of Colon and Rectal Surgeons