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Quality of Life Analysis After Whipple Procedure. Retrospective Cohort Study

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Quality of Life Analysis After Whipple Procedure. Retrospective Cohort Study 1 /9 OPEN Received: 12 May, 2020 ▶ Accepted: 14 August, 2020 ▶ Online first: 5 October, 2020 doi: https://doi.org/10.5554/22562087.e946 Quality of life analysis after Whipple procedure. Retrospective cohort study Análisis de calidad de vida en cirugía Whipple. Estudio de cohorte retrospectiva ARTICLE ORIGINAL Juan Pablo Aristizábal-Linaresa , Cristina Quevedo-Véleza, Paola Sánchez-Zapatab a Clínica CES. Medellín, Colombia b Universidad CES, Medellín, Colombia Correspondence: Calle 58 # 50C-2, Prado Centro. Medellín, Colombia. E-mail: [email protected] Abstract What do we know about this Introduction problem? Patient reported outcomes establish the patient’s own perception about his/her health and enable the development of policies designed to improve health/disease processes. • Patient reported outcomes (PRO) are These are particularly helpful in the case of diseases with a significant impact on the effectively measured using questionnaires, patient’s quality of life. apps or over the phone interviews, and measure the quality of life and the overall Objective perception about the health status. To compare the quality of life scores assessed using the EQ-5D-5L questionnaire in patients • Multiple trials have shown the undergoing cephalic duodenopancreatectomy (Whipple procedure) and laparoscopic adoption of PRO following cephalic cholecystectomies in the same hospital. duodenopancreatectomy (DPC), with controversial reports in terms of quality of Methodology life and going back to normal everyday life Retrospective cohort trial between July 2018 and February 2020. Patients programmed activities. for cephalic duodenopancreatectomy were included, regardless of the type of pathology, and over 18 years old. Patients with carcinomatosis or vascular infiltration were excluded. The EQ-5D-5L was administered following Whipple surgery and compared against a control group (laparoscopic cholecystectomy). The demographic What does this new trial characteristics, the diagnosis, hospital stay and 60-day mortality were assessed. contribute? Results • Study in Latin population adopting A total of 68 patients were included. The most frequent diagnosis was pancreatic PRO following DPC, using the EQ-5D-5L cancer (30 %) in the Whipple group and lithiasis (100 %) in the control group. In the questionnaire, compared against a control five dimensions assessed, there were no differences in terms of mobility (OR: 0.41, 95 group. % CI [0.30-0.57], p = 0.103) and in terms of personal care (OR: 0.42, 95 % CI [0.32-0.58], • The overall health perception following DPC p = 0.254). There was a difference in daily life activities (OR: 0.38, 95 % CI [0.27-0.54], p is slightly lower than in patients undergoing = 0.017), pain/malaise (OR: 2.33, 95 % CI [0.99-5.48]), p = 0.013 and anxiety/depression laparoscopic cholecystectomy. (OR: 0.39, 95 % CI [0.28-0.55], p = 0.019). The overall health perception was 80 points • The differences in quality of life perception for Whipple (IQR 60-90) vs. 100 points for the control group (IQR 90-100). are based on: increased pain, presence of anxiety/depression and disruption of activities Conclusions Patients undergoing a Whipple procedure experience a health perception slightly lower of daily life. than patients undergoing laparoscopic cholecystectomy. This difference may be associated with increased pain, anxiety/depression and a reduction in their activities of daily life. The administration of the EQ-5D-5L questionnaire to measure quality of life is a friendly tool that How to cite this article: used be used routinely to plan activities aimed at improving medical care. Aristizábal-Linares JP, Quevedo-Vé- lez C, Sánchez-Zapata P. Quality of life analysis after Whipple procedu- Keywords re. Retrospective cohort study. Co- Pancreaticoduodenectomy; quality of life; morbidity; patient reported outcome measures; lombian Journal of Anesthesiology. neoplasm. 2021;49:e946. Read the English version of this article on the journal website www.revcolanest.com.co Copyright © 2021 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 2/9 colombian journal of anesthesiology. 2021;49:e946. Resumen Introducción Los desenlaces informados por el paciente permiten establecer cuál es la percepción que tiene de su salud y crear políticas que mejoren procesos en salud/enfermedad. Son particularmente útiles en enfermedad que afectan la calidad de vida de forma importante. Objetivo Comparar las puntuaciones de calidad de vida evaluadas mediante el cuestionario EQ-5D-5L en pacientes sometidos a duodenopancreatectomía cefálica (procedimiento de Whipple) y colecistectomías laparoscópicas en el mismo centro hospitalario. Metodología Estudio de cohorte retrospectivo entre julio de 2018 y febrero de 2020. Se incluyeron pacientes programados para duodenopancreatectomía cefálica independientemente del tipo de patología y mayor de 18 años de edad; se excluyeron pacientes con carcinomatosis o infiltración vascular. Se aplicó el cuestionario EQ-5D-5L después de cirugía Whipple y se comparó con un grupo control (colecistectomía laparoscópica). Se evaluaron características demográficas, diagnóstico, estancia hospitalaria y mortalidad a 60 días. Resultados Se incluyeron 68 pacientes. El diagnóstico más frecuente fue cáncer de páncreas (30 %) en el grupo Whipple y litiasis (100 %) en el grupo control. En las 5 dimensiones evaluadas no hubo diferencias en movilidad (OR: 0,41, IC 95 % [0,30-0,57], p = 0,103) y en cuidado personal (OR: 0,42, IC 95 % [0,32-0,58], p = 0,254). Se encontró diferencia en actividades cotidianas (OR: 0,38, IC 95 % [0,27-0,54], p = 0,017), dolor/malestar (OR: 2,33, IC 95 % [0,99-5,48]), p = 0,013 y angustia/depresión (OR: 0,39, IC 95 % [0,28-0,55], p = 0,019). La percepción general de salud fue 80 puntos para Whipple (RIQ 60-90) vs. 100 puntos para el grupo control (RIC 90-100). Conclusiones Los pacientes sometidos a Whipple presentan una percepción de salud ligeramente menor que los pacientes de colecistectomía laparoscópica. Esta diferencia puede estar relacionada con el aumento en dolor, angustia/depresión y disminución en actividades cotidianas. La aplicación del cuestionario EQ-5D-5L para medición de calidad de vida es una herramienta fácil de aplicar que debería realizarse rutinariamente para planear intervenciones dirigidas a mejorar la atención médica. Palabras clave Pancreatoduodenectomía; calidad de vida; complicaciones; cuestionario; morbilidad. INTRODUCTION Historically, in 1948, the world Health patient, but on the family and the people Organization (WHO) defined health as around them. (7) Cephalic duodenopancreatectomy (DPC or “a state of complete physical, mental Patient reported outcomes (PRO), in Whipple procedure) has undergone several and social well-being and not merely the terms of medical therapy-associated quality technical transformations since it was absence of disease or infirmity”. (4) Later, of life, may be considered a compensation originally described over one century ago. this definition was accompanied by the measurement between the benefit of This procedure us indicated for pancreatic term quality of life, which evolved from a surviving, the toxicity of the treatment, and neoplasms, and less often for chronic conceptual definition to a series of scales the physical and emotional wellbeing of pancreatitis or cystic lesions. (1) The initial and questionnaires used to measure the patients. (8) Currently there are a number mortality was of around 30 % and there overall perception of the individual, in of generic, multidimensional instruments are current reports of up to 4 % in high terms of functionality, pain, disability, and designed for all types of cancer, an even volume institutions; however, the mortality and mental state. (5,6) Moreover, the for chronic pathologies. ranges between 30 and 60 %. (2) The most ongoing technological evolution and target There are several studies – with frequent postoperative complications therapies of cancer patients – including controversial reports – in terms of quality are delayed gastric emptying, pancreatic pancreatic cancer – have been able to of life after DPC due to adenocarcinoma or fistula and surgical wound infection, improve their survival and long term chronic pancreatitis with discretely lower which reflects in the rate of readmissions, results. However, these pathologies are scores in the quality of life indicators as reinterventions and longer hospital stay. accompanied by distressing symptoms compared against patients undergoing These aspects impact the patient’s quality that negatively affect functionality and laparoscopic cholecystectomy. (9) However, of life, which is extremely important but quality of life, even long after the initiation another prospective trial in patients seldom assessed. (3) of treatment, with an impact not just on the with pancreatic resection (68 % due to colombian journal of anesthesiology. 2021;49:e946. 3/9 pancreatic adenocarcinoma) showed that months was required. All variables, except health and 100 the best imaginable health; the quality of life decreases during the exposure to the quality of life question- every patient is required to give his/her three postoperative weeks, but then return naire, were accurately collected from each numeric answer. to the preoperative baseline levels and patient’s electronic medical record, and the For the sake of completeness of this is maintained
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