Measuring the impact of delayed access to elective cholecystectomy through patient's cost-utility: an observational cohort study.

BACKGROUND: Deferral of surgeries due to COVID-19 has negatively affected access to elective surgery and may have deleterious consequences for patient's health. Delays in access to elective surgery are not uniform in their impact on patients with different attributes. The objective of this study is to measure the change in patient's cost utility due to delayed elective cholecystectomy. METHODS: This study is based on retrospective analysis of a longitudinal sample of participants who have had elective cholecystectomy and completed the EQ-5D(3L) measuring health status preoperatively and postoperatively. Emergent cases were excluded. Patients younger than 19 years of age, unable to communicate in English or residing in a long-term care facility were ineligible. Quality-adjusted life years attributable to cholecystectomy were calculated by comparing health state utility values between the pre- and postoperative time points. The loss in quality-adjusted life years due to delayed access was calculated under four assumed scenarios regarding the length of the delay. The mean cost per quality-adjusted life years are shown for the overall sample and by sex and age categories. RESULTS: Among the 646 eligible patients, 30.1% of participants (N = 195) completed their preoperative and postoperative EQ-5D(3L). A delay of 12 months resulted in a mean loss of 6.4%, or 0.117, of the quality-adjusted life years expected without the delay. Among patients older than 70 years of age, a 12-month delay in their surgery corresponded with a 25.1% increase in the cost per quality-adjusted life years, from $10 758 to $13 463. CONCLUSIONS: There is a need to focus on minimizing loss of quality of life for patients affected by delayed surgeries. Faced with equal delayed access to elective surgery, triage may need to prioritize older patients to maximize their health over their remaining life years.

Effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension: A randomized controlled trial.

PURPOSE: Anxiety is one of the most important causes of hypertension, increasing direct blood pressure and affecting postoperative morbidity and mortality. The aim of this study was to investigate the effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension. METHODS: We enrolled 90 patients with hypertension undergoing cholecystectomy in this trial. Patients were randomly divided into two groups using a sealed-envelope system. Group STOR was shown the operating room the day before surgery, while Group No STOR was not shown the operating room. RESULTS: State-Trait Anxiety Inventory scores measured on the day of surgery were lower for Group STOR (43.2 ± 6.0) than Group No STOR (49.8 ± 7.9) (p = .001). Systolic (p = .001, p = .006, respectively), diastolic (p = .001, p = .004, respectively), and heart rate (p = .018, p = .031, respectively) values in the operation room and preoperative unit were lower in Group STOR than in Group No STOR. The number of postponed operations in Group STOR was lower than in Group No STOR (p = .043), and the patient satisfaction score in Group STOR was higher than in Group No STOR (p = .031). CONCLUSION: In patients with hypertension, preoperative anxiety, blood pressure, heart rate, and respiratory rate all increase in the preoperative unit and operation room. Our findings indicate that showing the operating room to patients with hypertension decreases preoperative anxiety, as well as blood pressure and heart rate inside the operating room and preoperative unit. It also reduces the number of postponed operations and increases patient satisfaction.

Surgical Consultation as Social Process: Implications for Shared Decision Making.

OBJECTIVE: This qualitative study examines surgical consultation as a social process and assesses its alignment with assumptions of the shared decision-making (SDM) model. SUMMARY OF BACKGROUND DATA: SDM stresses the importance of patient preferences and rigorous discussion of therapeutic risks/benefits based on these preferences. However, empirical studies have highlighted discrepancies between SDM and realities of surgical decision making. Qualitative research can inform understanding of the decision-making process and allow for granular assessment of the nature and causes of these discrepancies. METHODS: We observed consultations between 3 general surgeons and 45 patients considering undergoing 1 of 2 preference-sensitive elective operations: (1) hernia repair, or (2) cholecystectomy. These patients and surgeons also participated in semi-structured interviews. RESULTS: By the time of the consultation, patients and surgeons were predisposed toward certain decisions by preceding events occurring elsewhere. During the visit, surgeons had differential ability to arbitrate surgical intervention and construct the severity of patients' conditions. These upstream dynamics frequently displaced the centrality of the risk/benefit-based consent discussion. CONCLUSION: The influence of events preceding consultation suggests that decision-making models should account for broader spatiotemporal spans. Given surgeons' authority to define patients' conditions and control service provision, SDM may be premised on an overestimation of patients' power to alter the course of decision making once in a specialist's office. Considering the subordinate role of the risk/benefit discussion in many surgical decisions, it will be important to study if and how the social process of decision making is altered by SDM-oriented decision aids that foreground this discussion.

The Effect of Surgical Stress on Postoperative Tαß and Tγδ Cell Distribution.

BACKGROUND: It was previously shown that appropriate distribution of immune cells between different tissues and organs of the body is required for proper function of the immune system. Our previous experiments demonstrated that surgical trauma in mice induces Tγδ lymphocyte migration from peripheral blood to peritoneal lymphoid organs. Tγδ cells have regulatory activity as they suppress the cell-mediated immune response in vitro via TGF-ß. In the current study, we aim to evaluate the influence of surgery on both Taß and Tγδ lymphocyte distribution in patients that underwent operation. MATERIALS AND METHODS: We investigated the percentage of Tαß and Tγδ cells in peripheral blood of patients undergoing standard surgical procedures (gastric resection, colorectal resection, cholecystectomy, and strumectomy) before and 3 days after operation. The percentage of Tαß and Tγδ cells was evaluated by FACS Canto II cytofluorimeter. RESULTS: We showed that only major surgery located in the peritoneal cavity (gastric and colorectal surgery) decreases the percentage of Tγδ cells in peripheral blood as opposed to less traumatic surgery (strumectomy and cholecystectomy) which does not have such effect. However, significant reduction of Tγδ cells after operation was only observed in a group of patients that underwent gastrectomy. Additionally, we found that gastrectomy results in significant reduction of cumulative Tγδ CD4 and Tγδ CD25 lymphocyte counts. CONCLUSION: Surgery results in decreased percentage of Tγδ lymphocytes in peripheral human blood, and this correlates with the severity and location of the surgical trauma. This observation may help to predict postoperative recovery after gastroabdominal surgery.

The influence of perceived family support on post surgery recovery.

The objective of this work was to investigate the possible relationship between perceived family support, levels of cortisol and post surgery recovery. The study sample comprised 42 patients that were due to undergo open cholecystectomy surgery in a Regional Health Authority Reference Centre of the Autonomous Community of Extremadura in Spain. The FACES-II questionnaire was used for the evaluation of perceived family support and to measure the three fundamental dimensions of perceived family behaviour: cohesion, adaptability and family type. The day before surgery, a sample of saliva was taken from each subject in order to determine the level of cortisol. Results showed a clear relationship between family support and recovery. Patients with higher scores on the Cohesion Scale demonstrated better post surgery recovery (F = 8.8; gl = 40; p = .005). A relationship between levels of cortisol, perceived family support and recovery was also revealed. Patients with lower scores on the Cohesion scale and higher cortisol levels demonstrated poorer post surgery recovery (F = 10.96; gl = 40; p = .006). These results are coherent with other studies that have highlighted the beneficial effects of perceived family support on mental and physical health.

Psychosocial characteristics and pain burden of patients with suspected sphincter of Oddi dysfunction in the EPISOD multicenter trial.

OBJECTIVES: Patients with several painful functional gastrointestinal disorders (FGIDs) are reported to have a high prevalence of psychosocial disturbance. These aspects have not been studied extensively in patients with suspected Sphincter of Oddi dysfunction (SOD). METHODS: A total of 214 patients with post-cholecystectomy pain and suspected SOD were enrolled in seven US centers in a multicenter-randomized trial (Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction). Baseline assessments included pain descriptors and burden, structured psychosocial assessments of anxiety/depression, coping, trauma, and health-related quality of life. Patients with high levels of depression, suicidal ideation, or psychosis were excluded. RESULTS: The study population (92% female, mean age 38) reported anxiety (9%), depression (8%), past sexual trauma (18%), and physical abuse (10%). Of the total screened population (n=1460), 3.9% of the patients were excluded because of the presence of defined severe psychological problems. The mean medical outcomes study short-form-36 (SF-36) physical and mental composite scores were 38.70 (s.d.=7.89) and 48.74 (s.d.=9.60), respectively. Most subjects reported symptoms of other FGIDs. There were no correlations between the extent of the pain burden in the 3 months before enrollment and the baseline anxiety scores or victimization history. However, those with greater pain burden were significantly more depressed. There were no meaningful differences in the psychosocial parameters in subjects with or without irritable bowel, and those who had cholecystectomy for stones or functional gallbladder disease. Those declining randomization were comparable to those randomized. CONCLUSIONS: Psychosocial comorbidity in SOD is high. However, it does not appear to differ significantly from that reported in surveys of age- and gender-matched general populations, and may be lower than reported with other FGIDs.

Patients' experiences with cholecystitis and a cholecystectomy.

Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care.

Evaluation of sexual function in sexually active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients.

PURPOSE: The primary objective of this prospective cohort study was to investigate sexual function, quality of life and patient satisfaction in sexually active women 1 year after transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES). PATIENTS AND METHODS: This prospective single-centre cohort study included sexually active female patients after transvaginal hybrid NOTES cholecystectomy or anterior resection. Sexual life impairment and quality of life were assessed by the Gastrointestinal Quality of Life Index (GIQLI) prior and 1 year after surgery. Patient satisfaction was assessed as well as the sexual function 1 year postoperatively using the validated German version of the Female Sexual Function Index (FSFI-D). RESULTS: Between September 2008 and December 2009, 106 sexually active women after transvaginal hybrid NOTES cholecystectomy or anterior resection were identified. Sexual life significantly improved (GIQLI scores 3.2 ± 1.0 preoperatively vs. 3.7 ± 0.7 1 year postoperatively, P < 0.001), and painful sexual intercourse (3.3 ± 1.0 vs. 3.6 ± 0.7, P = 0.008) decreased post-surgery. The mean FSFI-D total score after transvaginal NOTES was 28.1 ± 4.6, exceeding the cutoff for sexual dysfunction defined as 26. Four (4.5 %) out of 88 patients who answered this question were not satisfied with the transvaginal hybrid NOTES procedure. CONCLUSIONS: This prospective cohort study of female sexual function after transvaginal NOTES provides compelling evidence that the transvaginal access is safe and associated with high satisfaction rate.

[The quality of life after cholecystectomy].

The quality of life (QOL) of three groups of patients who had undergone the routine cholecystectomy (RCE), laparoscopic cholecystectomy (LCE), or cholecystectomy using the minilaparatomy approach (MCE). QOL was assessed using the standard SF-36 questionnaire and on selected criteria. The postoperative complications rate after any version of cholecystectomy did not exceed the average rate in other studies. Patients with a history of LCE and MCE, returned to their normal social and intellectual activity faster; they reported higher perception and judgment on the state of their health and well-being, which in turn suggests the higher quality of life. Patients after RCE reported worse results due to a longer recovery period.

Qualitative and quantitative analysis of women's perceptions of transvaginal surgery.

BACKGROUND: Prior surveys evaluating women's perceptions of transvaginal surgery both support and refute the acceptability of transvaginal access. Most surveys employed mainly quantitative analysis, limiting the insight into the women's perspective. In this mixed-methods study, we include qualitative and quantitative methodology to assess women's perceptions of transvaginal procedures. METHODS: Women seen at the outpatient clinics of a tertiary-care center were asked to complete a survey. Demographics and preferences for appendectomy, cholecystectomy, and tubal ligation were elicited, along with open-ended questions about concerns or benefits of transvaginal access. Multivariate logistic regression models were constructed to examine the impact of age, education, parity, and prior transvaginal procedures on preferences. For the qualitative evaluation, content analysis by independent investigators identified themes, issues, and concerns raised in the comments. RESULTS: The completed survey tool was returned by 409 women (grouped mean age 53 years, mean number of 2 children, 82% ≥ some college education, and 56% with previous transvaginal procedure). The transvaginal approach was acceptable for tubal ligation to 59%, for appendectomy to 43%, and for cholecystectomy to 41% of the women. The most frequently mentioned factors that would make women prefer a vaginal approach were decreased invasiveness (14.4%), recovery time (13.9%), scarring (13.7%), pain (6%), and surgical entry location relative to organ removed (4.4%). The most frequently mentioned concerns about the vaginal approach were the possibility of complications/safety (14.7%), pain (9%), infection (5.6%), and recovery time (4.9%). A number of women voiced technical concerns about the vaginal approach. CONCLUSIONS: As in prior studies, scarring and pain were important issues to be considered, but recovery time and increased invasiveness were also in the "top five" list. The surveyed women appeared to actively participate in evaluating the technical components of the procedures.

Trait anxiety predicts outcome 6 weeks after cholecystectomy. A prospective follow-up study.

BACKGROUND: A substantial group of patients with gallstone disease experience negative outcome after surgical removal of the gallbladder (cholecystectomy). Early identification of these patients is important. PURPOSE: The aim of the study is to identify predictors (clinical symptoms and trait anxiety) of negative symptomatic outcomes at 6 weeks after cholecystectomy. METHODS: Consecutive patients (n = 133), 18-65 years, with symptomatic gallstone disease, completed symptom checklists and the state-trait anxiety inventory preoperatively and at 6 weeks after cholecystectomy. RESULTS: High trait anxiety was the only predictor of persistence of biliary symptoms at 6 weeks after cholecystectomy (OR = 6.88). CONCLUSION: In addition to clinical symptoms, high trait anxiety is a predictor of negative symptomatic outcome at 6 weeks after cholecystectomy. Trait anxiety should be evaluated to aim at a patient-tailored approach in gallstone disease.

[Psychosomatic aspects of pathology of biliary passages].

The work was designed to study psychological features of patients with hypomotor dysfunction of biliary passages, chronic non-calculous cholecystitis with and without opistorchosis and cholelithiasis before and after cholecystectomy. A total of 343 patients were examined between 1997 and 2007. The control group comprised 100 age- and sex-matched healthy subjects. All patients signed the informed consent. Significance of the difference between absolute and relative parameters was estimated using Student's t-test at three significance levels (0.05, 0.001, 0.001---??). There were no differences between psychological status of patients with biliary duct pathology, but they were significantly different from controls as regards this variable. Patients with different forms of biliary duct pathology showed unidirectional changes of psychological symptoms that deteriorated with severity of the main disease. The psychological portrait of the patients suggested emotionally labile, hypochondriac, irritable, self-confident, highly anxious and neurotic personality type.

Increased Risk of Major Depressive Disorder After Cholecystectomy: A Nationwide Population-Based Cohort Study in Korea.

INTRODUCTION: This study investigated the risk of depression in Korean adults who underwent cholecystectomy and appeared for subsequent long-term follow-ups. A national population-based data set was used for analysis. METHODS: All patients (n = 111,934) aged 40 years and older who underwent cholecystectomy between 2010 and 2015 and a control population (n = 223,868), matched for age and sex, were identified from the database of the Korean National Health Insurance Corporation. The hazard ratio (HR) and 95% confidence interval (CI) of depression were estimated after cholecystectomy, and a Cox regression analysis was performed. RESULTS: The incidence of depression in the cholecystectomy group was 27.3 per 1,000 person-years and that in the control group was 20.3 per 1,000 person-years. Patients who underwent cholecystectomy showed an increased risk of major depressive disorder (MDD) with an adjusted HR (aHR) of 1.34 (95% CI: 1.31-1.37, P < 0.001). The mean follow-up period after a 1-year lag was 3.67 ± 1.79 years. In the subgroup analysis, the risk of developing MDD after cholecystectomy was relatively high in patients aged 40-49 years (aHR 1.51, 95% CI: 1.44-1.58) and in participants without diabetes mellitus (aHR: 1.36, 95% CI: 1.33-1.39), hypertension (aHR: 1.38, 95% CI: 1.34-1.42), or dyslipidemia (aHR: 1.35, 95% CI: 1.32-1.38). DISCUSSION: Compared with the control population, patients who underwent cholecystectomy exhibited an increased incidence of MDD. Thus, physicians should implement an enhanced program of MDD screening for at least several years after cholecystectomy.

Trait anxiety predicts unsuccessful surgery in gallstone disease.

OBJECTIVE: To identify predictors of negative symptomatic outcomes at 6 months after cholecystectomy, surgical removal of the gallbladder, which is the preferred treatment for gallstone disease. After cholecystectomy, a substantial number of patients report persistence of symptoms. METHODS: In this prospective follow-up study, consecutive patients (n = 172) diagnosed with symptomatic gallstone disease and indicated for elective cholecystectomy were investigated. Preoperatively and at 6 months, patients completed self-report symptom checklists. The Spielberger State-Trait Anxiety Inventory scale was completed preoperatively and patients with a score of > or = P 80 were considered having High Trait Anxiety (HTA). Multivariate regression analyses were used to investigate independent predictors of persisting symptoms. RESULTS: Six months after cholecystectomy, patients with HTA were more likely to report persisting biliary symptoms than patients without HTA (NHTA) (45.5% versus 14.3%; chi(2) = 8.78, p = .002). HTA was identified as an independent predictor of persisting biliary symptoms at 6 months (odds ratio [OR], 3.08, p = .047; 95% confidence interval [CI], 1.02-9.34), in addition to the report of nonspecific symptoms (OR, 6.16, p = .024; 95% CI, 1.27-29.82), and the use of psychotropic medication (OR, 4.76, p = .023; 95% CI, 1.24-18.34). CONCLUSION: Patients with HTA have a three times higher risk at persisting biliary symptoms at 6 months after cholecystectomy than NHTA patients. Both clinical factors and the patient's personality should be considered in clinical decision making and risk estimation in elective cholecystectomy.

Is Cholecystectomy Really Harmful? A Long-Term Quality of Life Study in Living Donor Liver Transplantation.

BACKGROUND: Living donor liver transplantation (LDLT) is an accepted option for patients with end-stage liver disease. However, it potentially carries the risk of donor morbi-mortality, as well as long-term functional impairment. Cholecystectomy is performed routinely in the donor intervention, but the long-term effect on gastrointestinal (GI)-related quality of life (QoL) has never been explored previously. This study evaluated living donors' overall, abdominal wall-related, activity-level, and GI-related QoL. MATERIALS AND METHODS: In total, 21 living liver donors (LLD) (57% women, mean age 45 ± 9 years) were compared to a control group (29 patients) undergoing cholecystectomy for gallbladder polyps (45% women, mean age of 46 ± 7 years). LLD and controls (Ctl) were divided into 2 age groups: LLD-Y and Ctl-Y (25-45 years); and LLD-O and Ctl-O (46-65 years). Generic SF-36, Gastrointestinal Quality of Life Index, EuraHS for abdominal wall status assessment, and International Physical Activity Questionnaire were performed. Standard age-adjusted Portuguese population SF-36 scores were used. RESULTS: Global QoL results were better than Portuguese population scores and not inferior when compared to controls, scoring higher in the LLD-Y group in domains as vitality and mental health (P < .05). The abdominal wall impact was minimal among LLD. The activity level was significantly higher in LLD-Y than in Ctl-Y. Overall GI-related QoL was very close to the maximum score, and GI symptoms were significantly less in LLD-O compared with Ctl-O. CONCLUSION: LDLT had no impact on donors' general, abdominal wall-related QoL or activity level. The performance of cholecystectomy apparently had no impact on the development of GI-related symptoms.

The minimal clinically important difference in the Gastrointestinal Quality-of-Life Index after cholecystectomy.

BACKGROUND: The minimal clinically important difference (MCID) for the Gastrointestinal Quality of Life Index (GIQLI) is unknown, which limits its application and interpretation. This study aimed to estimate MCIDs for the GIQLI scores of patients after they had undergone cholecystectomy. METHODS: This study had 267 participants. All the participants completed the GIQLI and four anchor items, namely, "How would you describe your overall symptoms, emotions, physical functions, and social functions since your last visit?" The response options were "much worse," "somewhat worse," "same," "somewhat better" and "much better." The MCID was defined according to those who responded with "somewhat better." RESULTS: The mean age of the participants was 57.81 ± 14.93 years, and 37.08% of the patients were women. The MCID group included 67, 78, 44, and 22 patients with MCIDs of 6.42, 6.86, 7.64 and 6.46 points respectively for scores on the symptoms, emotions, physical functions, and social functions subscales, respectively. The effect sizes of four anchors in the "somewhat better" group (0.38-0.49) exceeded those of the same group (0.25-0.38). CONCLUSIONS: This study showed that after patients had undergone cholecystectomy, the clinically significant mean changes in their scores on the GIQLI subscales for symptoms, emotions, physical functions, and social function were respectively 6.42, 6.86, 7.64, and 6.46 points. After patients have undergone cholecystectomy, the MCIDs for the GIQLI subscales can play an important role in interpretation of the scores, application of them in clinical practice, and verification of treatment effects.

Patient attitudes and expectations regarding natural orifice translumenal endoscopic surgery.

BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) has theoretical patient advantages. Because public attitude toward NOTES will influence its adoption, this study aimed to assess patients' opinions regarding the NOTES procedure. METHODS: For this study, 192 patients were surveyed. Both NOTES and laparoscopic surgery (LS) are described together with an example case. Presurgical patients rated the importance of various aspects of surgical procedures and their preference for cholecystectomy via NOTES or LS. RESULTS: Complication risks, recovery time, and postoperative pain were considered more important than cosmesis, cost, length of hospital stay, or anesthesia type (p < 0.001). In the self-reports, 56% of the respondents preferred NOTES for their cholecystectomy and 44% chose LS. The patients perceived NOTES as having less pain, cost, risk of complications, and recovery time but requiring more surgical skill than open surgery or LS (p < 0.04). College-educated patients were more likely to choose NOTES, whereas patients 70 years of age or older and those who had undergone previous flexible endoscopy were less likely to select NOTES (p < 0.04). Although 80% of the patients choosing NOTES still preferred it even if it carried a slightly greater risk than LS, their willingness to choose NOTES decreased as complications, cost, and hospital distance increased and as surgeon experience decreased (p < 0.001). This study had a limitation in that the survey population was from surgery clinics. CONCLUSION: A majority of the patients surveyed (56%) would choose NOTES for their cholecystectomy. The deciding characteristics of the patients were more education, youth, and no previous flexible endoscopy. Procedure-related risks, pain, and recovery time were more important than cosmesis, cost, length of hospital stay, and anesthesia type in the choice of a surgical approach. Patients were less willing to accept NOTES as risks and costs increased and as surgeon experience and availability decreased.

RAND-36-Item Health Survey: A Comprehensive Test for Long-term Outcome and Health Status Following Surgery.

BACKGROUND/AIM: The aim of this study was to assess the 3-year health status of cholecystectomy patients by the RAND-36 Survey. PATIENTS AND METHODS: Initially, 110 patients with symptomatic gallstone disease were randomized to undergo either minicholecystectomy (MC) (n=58) or laparoscopic cholecystectomy (LC) (n=52). RAND-36 survey was performed preoperatively, 4 weeks, 6 months and 3 years following surgery. RESULTS: RAND-36 scores improved in several RAND-36 domains in MC and LC groups with a similar postoperative course over the 3-year study period. In addition, at the 3-year follow-up telephone interview, no significant differences in patient-reported outcome measures between MC and LC patients were shown. The linear mixed effect model was used to test the overall significance of the RAND-36 survey during a 36-month follow-up period and the overall p-values were statistically significant in vitality, mental health (0.03), role physical and bodily pain domains. CONCLUSION: During the three years following cholecystectomy, four RAND-36 domains remained significantly higher, indicating a significant positive change in quality of life. RAND-36-Item Health Survey is a comprehensive test for analyzing long-term outcome and health status after cholecystectomy.

Effects of Preoperative Anxiety on Intraoperative Hemodynamics and Postoperative Pain.

OBJECTIVE: To determine the effects of the level of the anxiety of the patients on the intraoperative hemodynamic parameters and postoperative pain, patient satisfaction and the stay period at the hospital. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: General Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey, from December 2015 to February 2016. METHODOLOGY: Seventy-two patients were operated for elective cholecystectomy. They were asked to answer state-trait anxiety inventory (STAI) questionnaire. The patients were classified into two groups as high and low anxiety levels. The targeted variables were compared. RESULTS: There has not been found any significant relationship between the level of anxiety and age, gender, marial status, level of education, profession, general anesthesia, comobidity and postoperative shivering. However, patients with high preoperative anxiety scores had unstable hemodynamic parameters (arterial pressure, heart rate, peripheral oxygen saturation) intraoperatively, increased postoperative pain and analgesic consumption with dissatisfaction. CONCLUSION: Preoperative anxiety might cause hemodynamic problems in the intraoperative period, increased analgesic need and lower postoperative satisfaction of the patients in the postoperative period. It would be better to dispel the preoperative anxiety by conselling patient regar anesthesia, surgeon, and the institute.

Adrenocorticotropic Hormone (ACTH) and Cortisol Monitoring as Stress Markers During Laparoscopic Cholecystectomy: Standard and Low Intraabdominal Pressure and Open Cholecystectomy.

INTRODUCTION: In this study we wanted to examine the hormonal responses due to stress exposure during laparoscopic cholecystectomy with standard (12-15 mm / Hg) (LCSP) and low (6-8 mm / Hg) (LCLP) intraabdominal pressure and open cholecystectomy (OC), with particular emphasis on stress hormone responses. AIM: Determination of adrenocorticotropic hormone (ACTH) and cortisol stress hormones before and after laparoscopic cholecystectomy with standard and low insufflation pressure, determination of ACTH and cortisol values before and after open cholecystectomy and comparison of ACTH and cortisol values between the patient sub-groups. METHODS: In a prospective study conducted between July 2016 and February 2018, we involved 110 patients which were divided into two groups: 70 patients with laparoscopic cholecystectomy (LC) and 40 patients with open cholecystectomy (OC). The first group of patients was further divided into two subgroups of 35 patients, (subgroup LC with standard and subgroup LC with low intraabdominal pressure). All patients met the preset inclusion and exclusion criteria of the study. There were no statistically significant differences in the demographic characteristics of patients between the investigated groups. The stress hormones determined were adrenocorticotropic hormone (ACTH) and cortisol. RESULTS: During the first, second and seventh day postoperative day (POD),ACTH values were significantly lower (p <0.0001) in LCLP than in LCSP and OC groups. This was also the case for comparison in LCSP and OC groups. By comparing LC and OC groups during first, the second and seventh POD, there was a significant difference (p <0.0001) in the ACTH levels. The concentration of this hormone was higher in the OC group in all three cases. The first, second and seventh POD were also statistically significant (p <0.0001) in cortisol values and between LC and OC groups there was an increase in cortisol levels in patients operated by open method. There was also a significant difference (p <0.0001) in cortisol values measured between LCLP and LCSP groups in the investigated days. Cortisol levels were higher in patients in the LCSP group. CONCLUSION: During open and laparoscopic cholecystectomy the response of the body to stress increased. The stress response of the organism during laparoscopic cholecystectomy was less than during open cholecystectomy. The stress response of the organism during laparoscopic cholecystectomy with low insufflation pressure ( 6-8mmHg) was less than during laparoscopic cholecystectomy with standard insufflation pressure (12-15mmHg).