ABSTRACT
Few studies have assessed the role of sociodemographic characteristics on outcomes after a cholecystectomy. Our goal was to evaluate the influence of age and gender on the health related quality of life (HRQoL) changes after cholecystectomy in this prospective observational study of consecutive patients undergoing cholecystectomy. Patients completed the SF-36 and the Gastrointestinal Quality of Life Index (GIQLI) before intervention and 3 months later. The influence of age, gender, and the pre-intervention health status on the HRQoL changes was studied by multivariate regression analysis. Older patients had poorer HRQoL and their post-intervention improvement was lower than younger patients. Compared with men, women had worse health status before the intervention measured with both HRQoL tools. In the unadjusted analysis women had greater improvements than men, measured by the GIQLI, but not with the SF-36. However, after controlling for other relevant variables, the SF-36 measured lower improvements in women more often than men, but the GIQLI showed similar results for both. For men and women, the lower the pre-intervention health status the higher the post-operative improvement. Women presented with worse health status before the intervention and less improvement post-operatively after adjustments. The pre-intervention health status has an important role explaining changes after the intervention. A gender-related difference exists between what a generic and a disease-specific HRQoL instrument captures when measuring HRQoL improvement after cholecystectomy.
Subject(s)
Cholecystectomy , Quality of Life , Sickness Impact Profile , Age Factors , Comorbidity , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Postoperative Period , Prospective Studies , Regression Analysis , Sex FactorsABSTRACT
OBJECTIVE: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cholecystectomy. New diagnostic and treatment techniques have been developed in the last decade, so an updated appropriateness of indications tool was developed for cholecystectomy in patients with non-malignant diseases. The validity and reliability of panel results using this tool were tested. METHODS: Criteria were developed using a modified Delphi panel judgement process. The level of agreement between the panelists (six gastroenterologists and six surgeons) was analysed and the ratings were compared with those of a second different panel using weighted kappa statistics. RESULTS: The results of the main panel were presented as a decision tree. Of the 210 scenarios evaluated by the main panel in the second round, 51% were found appropriate, 26% uncertain, and 23% inappropriate. Agreement was achieved in 54% of the scenarios and disagreement in 3%. Although the gastroenterologists tended to score fewer scenarios as appropriate, as a group they did not differ from the surgeons. Comparison of the ratings of the main panel with those of a second panel resulted in a weighted kappa statistic of 0.75. CONCLUSIONS: The parameters tested showed acceptable validity and reliability results for an evaluation tool. These results support the use of this algorithm as a screening tool for assessing the appropriateness of cholecystectomy.
Subject(s)
Cholecystectomy/standards , Decision Making , Practice Guidelines as Topic , Age Factors , Aged , Algorithms , Cholecystectomy/statistics & numerical data , Cholelithiasis/surgery , Consensus , Decision Trees , Health Services Research , Humans , Middle Aged , SpainABSTRACT
Objetivo: traducir al español y validar el GIQLI, un cuestionario de medición de calidad de vida relacionada con la salud para patología gastrointestinal Pacientes y métodos: en el estudio se incluyen todos los pacientes con diagnóstico de colelitiasis, en lista de espera para ser intervenidos de colecistectomía, en tres hospitales públicos. A todos los pacientes se les pidió que cumplimentaran los cuestionarios GIQLI y SF-36 antes de la intervención y a los 3 meses de la misma. Se estudió la validez, fiabilidad y sensibilidad al cambio del GIQLI. Resultados: completaron ambos cuestionarios, antes y después de la colecistectomía, 353 pacientes. El GIQLI fue capaz de detectar diferencias según nivel de gravedad, medido por el número de cólicos previos, entre aquéllos con menos de 6 cólicos (puntuación total del GIQLI: 102,7) o más de 6 (89,2). Las áreas del GIQLI correlacionaron bien con el SF-36 (coeficiente de correlación de Pearson de 0,58 a 0,79). La consistencia interna de sus áreas fue buena ( de Cronbach de 0,70 a 0,86). La sensibilidad al cambio, medida por la media de respuesta estandarizada, de las áreas del GIQLI fue de 0,45 a 0,82, mejor que la del cuestionario genérico SF-36 (0,20 a 0,56).Conclusiones: la traducción de GIQLI al español proporciona una nueva herramienta de medición de la cálida de vida, para su uso en patología gastrointestinal. Nuestros resultados apoyan la validez, fiabilidad y sensibilidad al cambio de este cuestionario (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Quality of Life , Health Status Indicators , Translations , Surveys and Questionnaires , Cholelithiasis , Gastrointestinal Diseases , Follow-Up StudiesABSTRACT
OBJECTIVE: To translate into Spanish and validate the GIQLI, a health related quality of life questionnaire for gastrointestinal diseases. PATIENTS AND METHODS: All patients with a diagnosis of cholelithiasis, on waiting list to undergo a cholecystectomy, from three public hospitals, were included in this study. All patients were requested to fulfill the GIQLI and the SF-36 before and three months after the intervention. The validity, reliability and responsiveness of the GIQLI were studied. RESULTS: 353 patients completed both questionnaires before and after the intervention. The GIQLI was able to discriminate among levels of severity, measured by the number of previous biliary colics, between those with less (total GIQLI score: 102.7) or more than 6 colics (89.2). GIQLI domains correlated with those of the SF-36 (Pearson correlation coefficient from 0.58 to 0.79). Internal consistency of its domains was good (Cronbach alpha from 0.70 to 0.86). Responsiveness, measured by the standardized response mean, of the GIQLI ranged between 0.45 to 0.82, better than the generic questionnaire SF-36 (0.20 a 0.56). CONCLUSIONS: GIQLI translation into Spanish provides with a new tool to measure quality of life on gastrointestinal diseases. Our results support the validity, reliability and responsiveness of the GIQLI Spanish version.
