S. M. Wrenn1, D. Ramos-Valadez2, A. Cepeda-Benito3, P. Cataldo1 1University Of Vermont College Of Medicine,Department Of Surgery,Burlington, VT, USA 2Sanford Health,Surgery,Thief River Falls, MINNESOTA, USA 3University Of Vermont,Department Of Psychological Sciences,Burlington, VT VERMONT, USA
Introduction: As healthcare payment models shift increasingly toward value-based incentives, it is imperative that postoperative outcomes are both accurately assessed and correctly aligned with patient priorities regarding their recovery and care. In particular, the assessment of patient quality of life as it pertains to both laparoscopic and open colorectal surgery remains understudied.
Methods: Patients who underwent a colon or rectal surgical resection at a single academic medical center between 2009-2015 were identified and contacted via traditional mail. Subjects were offered to complete a voluntary hand-written 36-question survey regarding their perioperative and postoperative quality of life. Responders who enrolled in the study were stratified into subcategories (including laparoscopic vs. open groups, benign vs. malignant groups). Analysis was performed via both subjective reported data and objective data from the electronic medical record regarding their clinical course. Statistical analysis was performed for categorical variables via chi squared test, and unpaired t test for interval variables. Statistical significance was defined as p<.05.
Results:A total of 626 patients were queried, and 167 patients responded to the survey (27% response rate). 25% of patients reported their surgery was laparoscopic, 63.5% reported their surgery was open, and the rest did not respond or were unsure. 92.2% of responders were satisfied with their surgical recovery. Factors deemed most important to all responders included being cured of colorectal cancer (91%), not having a permanent ostomy or stoma (84%), and not having any complications after surgery (74%). Patients who underwent laparoscopic surgery reported a shorter hospital length of stay (p<.001), quicker return to full strength (p<.05), and smaller incision (p<.001) with greater satisfaction with the appearance of their scar (p<0.05).
Conclusion:Regardless of surgical technique or indication, patients in our study reported high levels of satisfaction with their surgical care. Laparoscopic colorectal resections do appear to have some significant advantages over traditional open procedures, however not in the categories deemed most important to patients. This research helps elucidate the quality outcomes that are truly considered most valuable to patients during their perioperative and postoperative colorectal surgical care.
