Quality of life among total laryngectomized patients undergoing speech rehabilitation: correlation between several instruments

OBJECTIVE: The aim of this study was to correlate several instruments currently used for the assessment of the quality of life of patients who underwent total laryngectomy and speech rehabilitation. METHODS: A cross-sectional, observational study was conducted with 38 patients after total laryngectomy and speech therapy aiming to develop oesophageal speech. The patients were divided into the following two groups (19 participants each): speakers and non-speakers. The quality of life instruments used were as follows: visual analogue scale (VAS); Voice Handicap Index (VHI); Voice-Related Quality of Life (V-RQOL); Functional Assessment of Cancer Therapy - Head & Neck (FACT-H&N); European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck (EORTC QLQ-H&N35); and University of Washington Quality of Life (UW-QOL). RESULTS: The V-RQOL global health domain exhibited a strong correlation with the VHI. The EORTC QLQ-C30 exhibited a moderate to strong correlation with the EORTC QLQ-H&N35 functional domain in both groups. The EORTC QLQ-C30 functional domain exhibited a strong to moderate correlation with all other instruments in both groups. The UW-QOL exhibited a moderate to strong correlation with the VHI and EORTC QLQ-C30 in both groups. CONCLUSION: The EORTC QLQ-C30, EORTC QLQ-H&N35 and UW-QOL were the instruments that most correlated with the remaining instruments, indicating that any of the three can be used to assess the quality of life of the target population regardless of oesophageal voice development.

Análise retrospectiva das tireoidectomias realizadas por residentes de cirurgia geral em hospital universitário / Retrospective analysis of the thyroidectomies performed by general surgery resident in a university hospital

Introdução: Com o objetivo de avaliar as complicações das tireoidectomias realizadas no Hospital Geral do Grajaú, da Faculdade de Medicina da UNISA, durante o período de novembro de 2000 a agosto de 2003, foram analisados retrospectivamente 105 prontuários. Métodos: Todas as cirurgias foram realizadas pelo residente do segundo ano de Cirurgia Geral sob a supervisão de um especialista. Os pacientes foram analisados de acordo com o gênero, idade, duração média da cirurgia, tempo de internação pós-operatório e complicações apresentadas. Resultados: Na série estudada, 85,7% dos pacientes (90 casos), era do gênero feminino. A idade média dos pacientes foi de 50,5 anos, tendo um predomínio de doenças benignas (84% dos casos). A tireoidectomia total foi realizada em 77,1% dos pacientes (81 casos) e 96% dos pacientes receberam alta em até 48 horas após a cirurgia. As complicações encontradas foram: hipocalcemia definitiva em 0,95% (um caso); paralisia transitória do nervo laríngeo recorrente em 2,85% (três casos) e definitiva em 1,9% (dois casos); hematoma com posterior necessidade de reabordagem em 1,9% (dois casos) e desenvolvimento de hipotireoidismo em 50% dos casos que foram submetidos à tireoidectomia não total e nenhum óbito. Conclusão: A tireoidectomia é um procedimento com baixa morbimortalidade, sendo segura, mesmo quando realizado por cirurgiões em treinamento, desde que sob a supervisão direta de um especialista.

Introduction: In order to evaluate the thyroidectomies done in Grajaú General Hospital - UNISA - Medical University from November, 2000 to August, 2003, 105 patients were retrospectively analyzed. Methods: All surgeries were performed by the general surgery 2nd year resident under a specialist supervision. The patients were analyzed according to the gender, age, average duration of the surgery, postoperative permanence into the hospital, and diagnosed complication. Results: In the analyzed series, 85.7% of the patients (90 cases), were women. The age average was 50.5 years-old with a predominance of benign pathology (84.4% of the cases). The total thyroidectomy was performed in 77.1% (81 cases) and 96% of the patients were discharged from hospital in 48 hours after surgery. The following complications were found: definitive hypocalcemia in 0.95% (1 case); transitory palsy of the laryngeal nerve in 2.85% (3 cases); definitive palsy of the laryngeal nerve in 1.9% (2 cases); hematoma with posterior need of reoperation in 1.9% (2 cases); development of hypothyroidism in 50% of the cases which underwent to non total thyroidectomy. There was no death. Conclusion: The thyroidectomy is a low morbimotality procedure and it is safe, even when performed by surgeons in training, since under straight specialist supervision.