Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: A randomized prospective trial

Kimberly M. Brown, B. Todd Moore, G. Brent Sorensen, Conrad H. Boettger, Fengming Tang, Phil G. Jones, Daniel J. Margolin

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Single-incision laparoscopic cholecystectomy (SILC) is a newer approach that may be a safe alternative to traditional laparoscopic cholecystectomy (TLC) based on retrospective and small prospective studies. As the demand for single-incision surgery may be driven by patient perceptions of benefits, we designed a prospective randomized study using patient-reported outcomes as our end points. Methods: Patients deemed candidates for either SILC or TLC were offered enrollment in the study. After induction of anesthesia, patients were randomized to SILC or TLC. Preoperative characteristics and operative data were recorded, including length of stay (LOS). Pain scores in recovery and for 48 h and satisfaction with wound appearance at 2 and 4 weeks were reported by patients. We used the gastrointestinal quality of life index (GIQLI) survey preoperatively and at 2 and 4 weeks postoperatively to assess recovery. Procedural and total hospital costs per case were abstracted from hospital billing systems. Results: Mean age of the study group was 44.1 years (±14.8), 87 % were Caucasian, and 77 % were female, with no difference between groups. Operative times were longer for SILC (median = 57 vs. 47 min, p = 0.008), but mean LOS was similar (6.8 ± 4.2 h SILC vs. 6.2 ± 4.8 h TLC, p = 0.59). Operating room cost and encounter cost were similar. GIQLI scores were not significantly different preoperatively or at 2 or 4 weeks postoperatively. Patients reported higher satisfaction with wound appearance at 2 weeks with SILC. There were no differences in pain scores in recovery or in the first 48 h, although SILC patients required significantly more narcotic in recovery (19 mg morphine equivalent vs. 11.5, p = 0.03). Conclusions: SILC is a longer operation but can be done at the same cost as TLC. Recovery and pain scores are not significantly different. There may be an improvement in patient satisfaction with wound appearance. Both procedures are valid approaches to cholecystectomy.

Original languageEnglish (US)
Pages (from-to)3108-3115
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number9
DOIs
StatePublished - Sep 2013

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Laparoscopic Cholecystectomy
Costs and Cost Analysis
Pain
Patient Reported Outcome Measures
Length of Stay
Wounds and Injuries
Quality of Life
Prospective Studies
Hospital Costs
Narcotics
Cholecystectomy
Operating Rooms
Operative Time
Patient Satisfaction
Morphine
Anesthesia
Age Groups

Keywords

  • Cholecystectomy
  • Costs
  • Laparoscopic cholecystectomy
  • Quality of life
  • Single-incision
  • Trials

ASJC Scopus subject areas

  • Surgery

Cite this

Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy : A randomized prospective trial. / Brown, Kimberly M.; Moore, B. Todd; Sorensen, G. Brent; Boettger, Conrad H.; Tang, Fengming; Jones, Phil G.; Margolin, Daniel J.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 9, 09.2013, p. 3108-3115.

Research output: Contribution to journalArticle

Brown, Kimberly M. ; Moore, B. Todd ; Sorensen, G. Brent ; Boettger, Conrad H. ; Tang, Fengming ; Jones, Phil G. ; Margolin, Daniel J. / Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy : A randomized prospective trial. In: Surgical Endoscopy and Other Interventional Techniques. 2013 ; Vol. 27, No. 9. pp. 3108-3115.
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abstract = "Background: Single-incision laparoscopic cholecystectomy (SILC) is a newer approach that may be a safe alternative to traditional laparoscopic cholecystectomy (TLC) based on retrospective and small prospective studies. As the demand for single-incision surgery may be driven by patient perceptions of benefits, we designed a prospective randomized study using patient-reported outcomes as our end points. Methods: Patients deemed candidates for either SILC or TLC were offered enrollment in the study. After induction of anesthesia, patients were randomized to SILC or TLC. Preoperative characteristics and operative data were recorded, including length of stay (LOS). Pain scores in recovery and for 48 h and satisfaction with wound appearance at 2 and 4 weeks were reported by patients. We used the gastrointestinal quality of life index (GIQLI) survey preoperatively and at 2 and 4 weeks postoperatively to assess recovery. Procedural and total hospital costs per case were abstracted from hospital billing systems. Results: Mean age of the study group was 44.1 years (±14.8), 87 {\%} were Caucasian, and 77 {\%} were female, with no difference between groups. Operative times were longer for SILC (median = 57 vs. 47 min, p = 0.008), but mean LOS was similar (6.8 ± 4.2 h SILC vs. 6.2 ± 4.8 h TLC, p = 0.59). Operating room cost and encounter cost were similar. GIQLI scores were not significantly different preoperatively or at 2 or 4 weeks postoperatively. Patients reported higher satisfaction with wound appearance at 2 weeks with SILC. There were no differences in pain scores in recovery or in the first 48 h, although SILC patients required significantly more narcotic in recovery (19 mg morphine equivalent vs. 11.5, p = 0.03). Conclusions: SILC is a longer operation but can be done at the same cost as TLC. Recovery and pain scores are not significantly different. There may be an improvement in patient satisfaction with wound appearance. Both procedures are valid approaches to cholecystectomy.",
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AU - Brown, Kimberly M.

AU - Moore, B. Todd

AU - Sorensen, G. Brent

AU - Boettger, Conrad H.

AU - Tang, Fengming

AU - Jones, Phil G.

AU - Margolin, Daniel J.

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N2 - Background: Single-incision laparoscopic cholecystectomy (SILC) is a newer approach that may be a safe alternative to traditional laparoscopic cholecystectomy (TLC) based on retrospective and small prospective studies. As the demand for single-incision surgery may be driven by patient perceptions of benefits, we designed a prospective randomized study using patient-reported outcomes as our end points. Methods: Patients deemed candidates for either SILC or TLC were offered enrollment in the study. After induction of anesthesia, patients were randomized to SILC or TLC. Preoperative characteristics and operative data were recorded, including length of stay (LOS). Pain scores in recovery and for 48 h and satisfaction with wound appearance at 2 and 4 weeks were reported by patients. We used the gastrointestinal quality of life index (GIQLI) survey preoperatively and at 2 and 4 weeks postoperatively to assess recovery. Procedural and total hospital costs per case were abstracted from hospital billing systems. Results: Mean age of the study group was 44.1 years (±14.8), 87 % were Caucasian, and 77 % were female, with no difference between groups. Operative times were longer for SILC (median = 57 vs. 47 min, p = 0.008), but mean LOS was similar (6.8 ± 4.2 h SILC vs. 6.2 ± 4.8 h TLC, p = 0.59). Operating room cost and encounter cost were similar. GIQLI scores were not significantly different preoperatively or at 2 or 4 weeks postoperatively. Patients reported higher satisfaction with wound appearance at 2 weeks with SILC. There were no differences in pain scores in recovery or in the first 48 h, although SILC patients required significantly more narcotic in recovery (19 mg morphine equivalent vs. 11.5, p = 0.03). Conclusions: SILC is a longer operation but can be done at the same cost as TLC. Recovery and pain scores are not significantly different. There may be an improvement in patient satisfaction with wound appearance. Both procedures are valid approaches to cholecystectomy.

AB - Background: Single-incision laparoscopic cholecystectomy (SILC) is a newer approach that may be a safe alternative to traditional laparoscopic cholecystectomy (TLC) based on retrospective and small prospective studies. As the demand for single-incision surgery may be driven by patient perceptions of benefits, we designed a prospective randomized study using patient-reported outcomes as our end points. Methods: Patients deemed candidates for either SILC or TLC were offered enrollment in the study. After induction of anesthesia, patients were randomized to SILC or TLC. Preoperative characteristics and operative data were recorded, including length of stay (LOS). Pain scores in recovery and for 48 h and satisfaction with wound appearance at 2 and 4 weeks were reported by patients. We used the gastrointestinal quality of life index (GIQLI) survey preoperatively and at 2 and 4 weeks postoperatively to assess recovery. Procedural and total hospital costs per case were abstracted from hospital billing systems. Results: Mean age of the study group was 44.1 years (±14.8), 87 % were Caucasian, and 77 % were female, with no difference between groups. Operative times were longer for SILC (median = 57 vs. 47 min, p = 0.008), but mean LOS was similar (6.8 ± 4.2 h SILC vs. 6.2 ± 4.8 h TLC, p = 0.59). Operating room cost and encounter cost were similar. GIQLI scores were not significantly different preoperatively or at 2 or 4 weeks postoperatively. Patients reported higher satisfaction with wound appearance at 2 weeks with SILC. There were no differences in pain scores in recovery or in the first 48 h, although SILC patients required significantly more narcotic in recovery (19 mg morphine equivalent vs. 11.5, p = 0.03). Conclusions: SILC is a longer operation but can be done at the same cost as TLC. Recovery and pain scores are not significantly different. There may be an improvement in patient satisfaction with wound appearance. Both procedures are valid approaches to cholecystectomy.

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