Health related quality of life six months following surgical treatment for secondary peritonitis – using the EQ-5D questionnaire

Background: To compare health related quality of life (HR-QoL) in patients surgically treated for secondary peritonitis to that of a healthy population. And to prospectively identify factors associated with poorer (lower) HR-QoL. Design: A prospective cohort of secondary peritonitis patients was mailed the EQ-5D and EQ-VAS 6-months following initial laparotomy. Setting: Multicenter study in two academic and seven regional teaching hospitals. Patients: 130 of the 155 eligible patients (84%) responded to the HR-QoL questionnaires. Results: HR-QoL was significantly worse on all dimensions in peritonitis patients than in a healthy reference population. Peritonitis characteristics at initial presentation were not associated with HR-QoL at six months. A more complicated course of the disease leading to longer hospitalization times and patients with an enterostomy had a negative impact on the mobility (p = 0.02), self-care (p <0.001) and daily activities: (p = 0.01). In a multivariate analysis for the EQ-VAS every doubling of hospital stay decreases the EQ-VAS by 3.8 points (p = 0.015). Morbidity during the six-month follow-up was not found to be predictive for the EQ-5D or EQ-VAS. Conclusion: Six months following initial surgery, patients with secondary peritonitis report more problems in HR-QoL than a healthy reference population. Unfavorable disease characteristics at initial presentation were not predictive for poorer HR-QoL, but a more complicated course of the disease was most predictive of HR-QoL at 6 month

Initial microbial spectrum in severe secondary peritonitis and relevance for treatment

This study aims to determine whether abdominal microbial profiles in early severe secondary peritonitis are associated with ongoing infection or death. The study is performed within a randomized study comparing two surgical treatment strategies in patients with severe secondary peritonitis (n = 229). The microbial profiles of cultures retrieved from initial emergency laparotomy were tested with logistic regression analysis for association with ‘ongoing infection needing relaparotomy’ and in-hospital death. No microbial profile or the presence of yeast or Pseudomonas spp. was related to the risk of ongoing infection needing relaparotomy. Resistance to empiric therapy for gram positive cocci and coliforms was moderately associated with ongoing abdominal infection (OR 3.43 95%CI 0.95–12.38 and OR 7.61, 95%CI 0.75–76.94). Presence of only gram positive cocci, predominantly Enterococcus spp, was borderline independently associated with in-hospital death (OR 3.69, 95%CI 0.99–13.80). In secondary peritonitis microbial profiles do not predict ongoing abdominal infection after initial emergency laparotomy. However, the moderate association of ongoing infection with resistance to the empiric therapy compels to more attention for resistance when selecting empiric antibiotic coverage

Factors associated with posttraumatic stress symptoms in a prospective cohort of patients after abdominal sepsis: a nomogram

Objective: To determine to what extent patients who have survived abdominal sepsis suffer from symptoms of posttraumatic stress disorder (PTSD) and depression, and to identify potential risk factors for PTSD symptoms. Design and setting: PTSD and depression symptoms were measured using the Impact of Events Scale-Revised (IES-R), the Post-Traumatic Symptom Scale 10 (PTSS-10) and the Beck Depression Inventory II (BDI-II). Patients and participants: A total of 135 peritonitis patients were eligible for this study, of whom 107 (80%) patients completed the questionnaire. The median APACHE-II score was 14 (range 12-16), and 89% were admitted to the ICU. Measurements and results: The proportion of patients with "moderate" PTSD symptom scores was 28% (95% CI 20-37), whilst 10% (95% CI 6-17) of patients had "high" PTSD symptom scores. Only 5% (95% CI 2-12) of the patients expressed severe depression symptoms. Factors associated with increased PTSD symptoms in a multivariate ordinal regression model were younger age (0.74 per 10 years older, p = 0.082), length of ICU stay (OR = 1.4 per doubling of duration, p = 0.003) and having some (OR = 4.9, p = 0.06) or many (OR = 55.5, p < 0.001) traumatic memories of the ICU or hospital stay. Conclusion: As many as 38% of patients after abdominal sepsis report elevated levels of PTSD symptoms on at least one of the questionnaires. Our nomogram may assist in identifying patients at increased risk for developing symptoms of PTSD

A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial)

Background. Conservative treatment of uncomplicated or mild diverticulitis usually includes antibiotic therapy. It is, however, uncertain whether patients with acute diverticulitis indeed benefit from antibiotics. In most guidelines issued by professional organizations antibiotics are considered mandatory in the treatment of mild diverticulitis. This advice lacks evidence and is merely based on experts' opinion. Adverse effects of the use of antibiotics are well known, including allergic reactions, development of bacterial resistance to antibiotics and other side-effects. Methods. A randomized multicenter pragmatic clinical trial comparin

Assessing preferences regarding healthcare interventions that involve non-health outcomes: an overview of clinical studies

Decision making in healthcare often involves decision alternatives that vary on different dimensions in conflicting ways, such as health benefits and costs. In such cases, it is not always easy to identify the best option, as a tradeoff has to be made. In preference studies, patients evaluate health states or healthcare strategies reflecting this trade-off. A focus that is restricted to only health outcomes in decision making may be too narrow. Patients also derive utility, or experience disutility, from healthcare processes themselves. A range of techniques is available for eliciting valuations of patients for these processes and other non-health outcomes. At present, it is unclear to what extent, and how, clinical evaluation studies have taken into account non-health outcomes. We performed a systematic review of trade-off and valuation studies to assess the extent to which valuations of process and non-health outcomes have actually been elicited from patients, in what specialty areas, and what techniques were used. We identified 567 articles that addressed patients’ preferences involving non-health outcomes. The main therapeutic fields were oncology (17%), gynecology/obstetrics (11%), pulmonology (11%), cardiology (7%), gastroenterology (6%), and infectious diseases (6%). There was an absolute increase from the early 1980s (a handful of studies published each year) to recent years (almost 100 publications per year). We noticed a strong increase in elicitation techniques aimed at identification of determinants of patients’ preferences. The number of studies addressing preferences for medical dilemmas involving non-health outcomes is steadily increasing and covers the whole spectrum of health-related interventions across all medical fields. A diversification in application fields as well as in research methods was observed, reflecting a lack of standardization. There is a need for methodological standards and evidence-based criteria to evaluate the methodological quality and clinical validity of studies that address preferences for dilemmas involving non-health outcomes.Brent C. Opmeer, Corianne A. J. M. de Borgie, Ben W. J. Mol and Patrick M. M. Bossuy

Assessing Preferences Regarding Healthcare Interventions that Involve Non-Health Outcomes: An Overview of Clinical Studies

Decision making in healthcare often involves decision alternatives that vary on different dimensions in conflicting ways, such as health benefits and costs. In such cases, it is not always easy to identify the best option, as a trade-off has to be made. In preference studies, patients evaluate health states or healthcare strategies reflecting this trade-off. A focus that is restricted to only health outcomes in decision making may be too narrow. Patients also derive utility, or experience disutility, from healthcare processes themselves. A range of techniques is available for eliciting valuations of patients for these processes and other non-health outcomes. At present, it is unclear to what extent, and how, clinical evaluation studies have taken into account non-health outcomes. We performed a systematic review of trade-off and valuation studies to assess the extent to which valuations of process and non-health outcomes have actually been elicited from patients, in what specialty areas, and what techniques were used. We identified 567 articles that addressed patients' preferences involving non-health outcomes. The main therapeutic fields were oncology (17%), gynecology/obstetrics (11%), pulmonology (11%), cardiology (7%), gastroenterology (6%), and infectious diseases (6%). There was an absolute increase from the early 1980s (a handful of studies published each year) to recent years (almost 100 publications per year). We noticed a strong increase in elicitation techniques aimed at identification of determinants of patients' preferences. The number of studies addressing preferences for medical dilemmas involving non-health outcomes is steadily increasing and covers the whole spectrum of health-related interventions across all medical fields. A diversification in application fields as well as in research methods was observed, reflecting a lack of standardization. There is a need for methodological standards and evidence-based criteria to evaluate the methodological quality and clinical validity of studies that address preferences for dilemmas involving non-health outcomes.Conjoint-analysis, Decision-making, Outcome-assessment-(health-care), Patient-preference, Utility-measurement