Patient reported outcomes in elective laparoscopic cholecystectomy

Abstract

Backgrounds/aims: Traditional outcome measures (e.g., length of hospital stay, morbidity, and mortality) are used to determine the quality of care, but these may not be most important to patients. It is unclear which outcomes matter to patients undergoing elective laparoscopic cholecystectomy (ELC). We aim to identify patient-reported outcome measures (PROM) which patients undergoing ELC valued most.

Methods: A 45-item questionnaire with Four-point Likert-type questions developed from prior literature review, prospectively administered to patients treated with ELC at a tertiary institution in Singapore.

Results: Seventy-five patients participated. Most essential factors were technical skill and experience level of a surgeon, long-term quality of life (QoL), patient involvement in decision-making, communication skill of a surgeon, cleanliness of the ward environment, and standards of nursing care. Least important factors were hospitalization leave duration, length of hospital stay, a family's opinion of the hospital, and scar cosmesis. Employed patients were more likely to find hospitalization leave duration (p<0.001) and procedure duration (p=0.042) important. Younger patients (p=0.048) and female gender (p=0.003) were more likely to perceive scar cosmesis as important.

Conclusions: Patients undergoing ELC value long-term QoL, surgeon technical skill and experience level, patient involvement in decision-making, surgeon communication skill, cleanliness of the ward environment, and nursing care standards. Day-case surgery, medical leave, family opinion of hospital, and scar cosmesis were least important. Understanding what patients value will help guide patient-centric healthcare delivery.

Keywords: Cholecystectomy; Cholecystolithiasis; Gallstones; Patient-reported outcomes.

Fig. 1. Patient perception on the procedure.

Fig. 2. Patient perception on the hospital experience.

Fig. 3. Patient perception on long-term outcomes.

Fig. 4. Percentage scores of what patients value the most. Top ranking factors are highlighted in dark blue. Lowest three ranking factors are highlighted in green.

Fig. 5. Priorities of healthcare stakeholders and potential conflicts. PROM, Patient Reported Outcome Measures.