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      Avoiding or Reversing Hartmann’s Procedure Provides Improved Quality of Life After Perforated Diverticulitis

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          Abstract

          Introduction

          The existing literature regarding acute perforated diverticulitis only reports about short-term outcome; long-term following outcomes have not been assessed before. The aim of this study was to assess long-term quality of life (QOL) after emergency surgery for perforated diverticulitis.

          Patients and Methods

          Validated QOL questionnaires (EQ-VAS, EQ-5D index, QLQ-C30, and QLQ-CR38) were sent to all eligible patients who had undergone emergency surgery for perforated diverticulitis in five teaching hospitals between 1990 and 2005. Differences were compared between patients that had undergone Hartmann’s procedure (HP) or resection with primary anastomosis (PA) and also compared to a sex- and age-matched sample of healthy subjects.

          Results

          Of a total of 340 patients, only 150 patients (44%) were found still alive in July 2007 (median follow-up 71 months). The response rate was 87%. In patients with PA, QOL was similar to the general population, whereas QOL after HP was significantly lower. The presence of a stoma was found to be an independent factor related to worse QOL. The deterioration in QOL was mainly due to problems in physical function and body image.

          Conclusions

          Survivors after perforated diverticulitis had a worse QOL than the general population, which was mainly due to the presence of an end colostomy. QOL may improve if these stomas are reversed or not be performed in the first place.

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          Most cited references26

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          Quality of life after stroke.

          Bradley R. King (1996)
          The purposes of this study were to examine overall and domain-specific quality of life in long-term stroke survivors and to identify variables that predict quality of life after stroke. The study used a cross-sectional, descriptive correlational design. Subjects were 86 stroke survivors who were interviewed 1 to 3 years after stroke. Quality of life was measured with the use of an instrument that assesses satisfaction and importance for four domains (health and functioning, socioeconomic, family, and psychological-spiritual). Independent variables were age, social class, aphasia, functional status, motor impairment, depression, comorbidity, and perceived social support. Multiple regression analysis was used to predict quality of life. Thirty percent of subjects scored in the depressed range. The mean overall quality of life score was relatively high and was comparable to that of a normative population. Quality of life was highest for the family domain and lowest for health and functioning. Depression, perceived social support, and functional status predicted quality of life (adjusted R2 = .38) and contributed to prediction of domain quality of life. Social support and three additional variables, social class, age, and cardiovascular disease, predicted socioeconomic quality of life. The identification of depression, social support, and functional status as predictors of quality of life suggests the need to assist stroke survivors in coping and in maintaining and strengthening their support systems.
          Article 0 comments Cited 90 times – based on 0 reviews     Review now
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            Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention.

            Maarten v Kleef, Stephan L M Peters, Erik Heineman … (2007)
            To identify somatic and psychologic predictors of pain, functional limitations, global perceived recovery, and quality of life 6 months after surgical intervention. Recent studies have indicated that chronic pain after surgical intervention is more common than previously assumed. Several demographic and somatic predictors of long-term unfavorable outcome have been identified, but little is known about the contribution of psychologic risk factors. A prospective cohort study, including 625 patients undergoing elective surgery at the University Hospital Maastricht, The Netherlands, was conducted between February and August 2003. Psychologic questionnaires were completed preoperatively and acute postoperative pain was recorded until 4 days after the operation. Six months later, all patients received follow-up questionnaires to assess pain, functional limitations, global perceived recovery, and quality of life. Multivariable logistic regression analyses were used to estimate relative risk of poor outcome in terms of pain, functional limitations, and global recovery. Multivariable linear regression analysis was used to assess associations with quality of life at 6 months. The most important somatic predictors of unfavorable outcome were duration of the operation and high levels of acute postoperative pain. Patients reporting high levels of pain 4 days after the operation and patients undergoing an operation of longer than 3 hours were at risk for increased pain, increased functional limitations, poor global recovery, and reported lower levels of quality of life 6 months after the operation. Psychologic variables that influenced long-term outcome were preoperative fear of surgery and optimism. Fear of the long-term consequences of the operation was associated with more pain, poor global recovery, and worse quality of life 6 months later, whereas optimism was associated with better recovery and higher quality of life. This study was the first to identify the joint contribution of somatic and psychologic factors to chronic pain, functional limitations, and quality of life 6 months after surgical interventions. It replicates previous findings that intense acute postoperative pain is a risk factor for long-term adverse outcome and also identified additional risk factors, namely, long duration of the operation, ASA status, and preoperative fear of surgery.
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              Clinical practice. Diverticulitis.

              Heiko Jacobs (2007)
              Article 0 comments Cited 84 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : +31-10-7040704 , j.vermeulen.1@erasmusmc.nl
                Journal
                Journal ID (nlm-ta): J Gastrointest Surg
                Title: Journal of Gastrointestinal Surgery
                Publisher: Springer-Verlag (New York )
                ISSN (Print): 1091-255X
                ISSN (Electronic): 1873-4626
                Publication date (Electronic): 2 February 2010
                Publication date PMC-release: 2 February 2010
                Publication date (Print): April 2010
                Volume: 14
                Issue: 4
                Pages: 651-657
                Affiliations
                [1 ]Department of Surgery, Erasmus University Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
                [2 ]Department of Surgery, Maasstad Hospital, Groene Hilledijk 315, 3075 EA Rotterdam, The Netherlands
                [3 ]Department for Medical Psychology and Psychotherapy, Erasmus University Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
                Article
                Publisher ID: 1155
                DOI: 10.1007/s11605-010-1155-5
                PMC ID: 2836251
                PubMed ID: 20127201
                SO-VID: 8ab33b16-3e85-48cc-93db-2bb797033d91
                Copyright © © The Author(s) 2010
                History
                Date received : 25 September 2009
                Date accepted : 4 January 2010
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © The Society for Surgery of the Alimentary Tract 2010

                ScienceOpen disciplines: Surgery
                Keywords: perforated diverticulitis,hartmann’s procedure,quality of life,primary anastomosis
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: perforated diverticulitis, hartmann’s procedure, quality of life, primary anastomosis

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