Major abdominal surgery for benign colorectal disease improves patient-reported quality of life

Patient-reported outcomes (PROs) on health status and quality of life (QOL) can be used to assess surgical interventions. Limited data are available on PROs for patients with benign colorectal disease undergoing elective major abdominal surgery.

Patients with benign colorectal disease including ulcerative colitis (UC), Crohn’s disease and diverticulitis were surveyed on PROs between 2012 and 2016. Included patients underwent an elective abdominal operation, in the form of a bowel resection or pelvic pouch procedure. Outcomes were assessed after placement on the surgical wait-list and 6 months after surgery. Survey instruments included a general health outcome questionnaire (EQ-5D, max score 1.0), an overall health status visual analog scale (VAS, max score 100), and assessment tools for pain (PEG, max score 10) and depression (PHQ-9, max score 27). Pre- and post-operative scores were compared using paired samples t-tests. 

Fifty-seven patients completed both pre- and post-operative surveys. Post-operative scores were significantly improved from pre-operative scores on the EQ-5D (mean score  standard deviation; 0.85 ± 0.17 vs. 0.78 ± 0.19, p=0.004), VAS (76.20 ± 18.02 vs. 66.93 ± 19.69, p=0.001), PEG (2.00 ± 2.35 vs. 2.85 ± 3.05, p=0.020), and PHQ-9 (3.86 ± 4.42 vs. 5.25 ± 5.43, p=0.016). Patients with Crohn’s disease (N=16) experienced the greatest pre-operative reductions in QOL and highest pain and depression scores. Average health status and pain scores improved significantly following surgery for the Crohn’s and diverticulitis (N=30) patients, but not the UC patients (N=11). Depression scores also improved significantly following surgery for the Crohn’s patients. 

Surgical intervention for benign colorectal disease improves patient-reported health status and QOL. Improvements are most pronounced for patients with Crohn’s disease and diverticulitis, possibly due to symptom burden prior to operative intervention. Surgery for ulcerative colitis may not result in significant improvements in health status outcomes as measured by the included tools.