Quality of life after colorectal surgery: A prospective study of patients compared with their spouses

doi:10.4240/wjgs.v13.i9.1050

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

World J Gastrointest Surg. Sep 27, 2021; 13(9): 1050-1062
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.1050

Table 1 Sociodemographic features of patients and their spouses (n = 100)

Sociodemographic features	Number of patients (male/female)	Number of spouses (male/female)
Type of surgery
APR (male/female)	33 (24/9)	33 (9/24)
LAR (male/female)	33 (17/16)	33 (16/17)
AR (male/female)	34 (15/19)	34 (19/15)
Age (yr)	57.4 ± 12.3 [57 (28-83)]	56.7 ± 12.1 [58 (26-85)]
Gender (male/female)	56/44	44/56
Educational level
Illiterate	6	12
Primary education	51	41
High school	26	32
College	17	15
Preoperative employment
Government employee	7	11
Self-employed	20	17
Retired	37	25
Unemployed	5	3
Housewife	31	44

Cells represent frequency except for age, mean ± SD [median (minimum-maximum)]. APR: Abdominoperineal resection; LAR: Low anterior resection; AR: Anterior resection.

Table 2 Correlation of the percentage change in quality of life scores between patients and their spouses

Scale	Subscale	Spearman’s correlation coefficient
WHODAS-II	Understanding and communication	0.183
	Getting around	0.037
	Self-care	0.349^b
	Getting along with people	0.189
	Life activities	0.323^b
	Participation in society	0.312^b
	Total	0.636^c
SF-36	Physical function	0.071
	Role physical	-0.170
	Bodily pain	0.246^a
	General health	0.233^a
	PCS	-0.035
	Vitality	0.271^b
	Social function	0.487^c
	Role emotional	0.483^c
	Mental health	0.359^c
	MCS	0.536^c

Cells represent Spearman’s correlation coefficients.

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

WHODAS-II: World Health Organization Disability Assessment Schedule II; SF-36: 36-item Short Form Survey; PCS: Physical component score; MCS: Mental component score.

Table 3 Comparison of quality of life changes in patients and their spouses according to type of surgery

Scale	Subscale	Patient				Spouse
		APR	LAR	AR	P value	APR	LAR	AR	P value
WHODAS-II	Understanding and communication	16 ± 29 [0 (-33; 100)]	1 ± 27 [0 (-100; 50)]	7 ± 19 [0 (0; 86)]	0.103	14 ± 30 [0 (0; 100)]	15 ± 53 [0 (-100; 151)]	2 ± 7 [0 (0; 25)]	0.241
	Getting around	24 ± 54 [0 (-100; 200)]	77 ± 133 [46 (-100; 500)]	10 ± 26 [0 (0; 100)]	0.001¹	8 ± 27 [0 (-33; 100)]	4 ± 26 [0 (-80; 100)]	-3 ± 17 [0 (-100; 11)]	0.467
	Self-care	4 ± 19 [0 (0; 100)]	1 ± 34 [0 (-100; 133)]	2 ± 13 [0 (0; 75)]	0.830	0	-3 ± 18 [0 (-100; 0)]	2 ± 9 [0 (0; 50)]	0.226
	Getting along with people	107 ± 173 [50 (-100; 800)]	64 ± 70 [88 (-33; 200)]	3 ± 23 [0 (-100; 50)]	<0.001²	25 ± 47 [0 (-100; 100)]	53 ± 67 [58 (-80; 200)]	15 ± 30 [0 (0; 150)]	0.099
	Life activities	34 ± 86 [0 (-33; 400)]	54 ± 86 [0 (-100; 300)]	11 ± 71 [0 (-100; 300)]	0.085	92 ± 128 [38 (0; 400)]	128 ± 210 [0 (-100; 800)]	10 ± 38 [0 (-100; 100)]	0.013²
	Participation in society	84 ± 66 [71 (-45; 300)]	97 ± 123 [71 (-100; 550)]	59 ± 70 [47 (-58; 300)]	0.036²	50 ± 52 [43 (-100; 200)]	63 ± 185 [13 (-100; 799)]	38 ± 36 [31 (-50; 114)]	0.013¹
	Total	83 ± 61 [57 (-41; 218)]	112 ± 150 [66 (-100; 635)]	55 ± 76 [29 (-57; 301)]	0.012²	69 ± 67 [67 (-100; 349)]	79 ± 89 [59 (-95; 301)]	34 ± 40 [27 (-33; 200)]	0.002²
SF-36	Physical function	-6 ± 10 [-4 (-44; 12)]	-8 ± 7 [-8 (-30; 3)]	0 ± 4 [0 (-11; 15)]	< 0.001³	0 ± 1 [0 (-7; 0)]	2 ± 12 [0 (-11; 65)]	-1 ± 4 [0 (-24; 0)]	0.936
	Physical role	-10 ± 20 [0 (-50; 14)]	-24 ± 32 [-29 (-50; 101)]	9 ± 29 [0 (0; 101)]	< 0.001³	0 ± 14 [0 (-50; 61)]	3 ± 13 [0 (-25; 33)]	1 ± 20 [0 (-50; 101)]	0.389
	Bodily pain	-16 ± 12 [-18 (-48; 12)]	-20 ± 15 [-19 (-53; 35)]	-8 ± 12 [-10 (-26; 24)]	< 0.001³	0 ± 9 [0 (-19; 24)]	-1 ± 15 [0 (-27; 68)]	-2 ± 7 [0 (-31; 11)]	0.690
	General health	-17 ± 12 [-18 (-50; 0)]	-20 ± 12 [-22 (-48; 15)]	-10 ± 8 [-13 (-21; 16)]	0.001³	-3 ± 4 [-2 (-18; 8)]	-5 ± 6 [-5 (-22; 7)]	-3 ± 5 [0 (-16; 0)]	0.077
	PCS	-10 ± 11 [-8 (-45; 13)]	-15 ± 11 [-19 (-35; 11)]	-3 ± 8 [-5 (-18; 32)]	< 0.001³	2 ± 7 [0 (-12; 18)]	8 ± 7 [9 (-4; 19)]	-0 ± 9 [0 (-30; 27)]	< 0.001¹
	Vitality	-7 ± 10 [-5 (-43; 5)]	-8 ± 13 [-10 (-19; 54)]	-4 ± 8 [-4 (-18; 28)]	0.019¹	-4 ± 7 [-4 (-23; 12)]	-6 ± 16 [-5 (-21; 70)]	-3 ± 5 [0 (-16; 5)]	0.029⁴
	Social function	-18 ± 14 [-19 (-37; 16)]	-22 ± 23 [-24 (-46; 61)]	-10 ± 17 [-13 (-47; 40)]	0.003³	-11 ± 13 [-12 (-38; 0)]	-22 ± 24 [-24 (-59; 61)]	-9 ± 11 [-12 (-40; 13)]	< 0.001¹
	Emotional role	-18 ± 38 [0 (-57; 133)]	-39 ± 39 [-57 (-57; 133)]	11 ± 39 [0 (-31; 133)]	< 0.001³	-3 ± 36 [0 (-57; 133)]	-30 ± 39 [-47 (-57; 133)]	3 ± 25 [0 (-47; 133)]	< 0.001¹
	Mental health	-9 ± 10 -6 (-33; 19)]	-12 ± 21 [-11 (-33; 91)]	-6 ± 9 [-5 (-31; 16)]	0.002¹	-7 ± 11 [0 (-31; 13)]	-8 ± 25 [-10 (-36; 115)]	-3 ± 8 [0 (-31; 8)]	0.007¹
	MCS	-16 ± 19 [-14 (-51; 44)]	-24 ± 30 [-32 (-45; 123)]	-4 ± 12 [-5 (-23; 25)]	< 0.001³	-11 ± 18 [-5 (-55; 28)]	-29 ± 34 [-38 (-62; 124)]	-4 ± 10 [-3 (-33; 35)]	< 0.001¹

Cells represent the mean ± SD [median (minimum-maximum)].

¹Low anterior resection (LAR) is different.

²Anterior resection (AR) is different from others.

³All are different.

⁴LAR is different from AR.

PCS: Physical component score; MCS: Mental component score; WHODAS-II: World Health Organization Disability Assessment Schedule II; SF-36: 36-item Short Form Survey; APR: Abdominoperineal resection; LAR: Low anterior resection; AR: Anterior resection.

Table 4 Comparison of the changes in patients’ and spouses’ quality of life according to gender

		Patient			Spouse
Scale	Subscale	Male	Female	P value	Male	Female	P value
WHODAS-II	Understanding andcommunication	8 ± 28 [0 (-100; 100)]	9 ± 24 [0 (-27; 86)]	0.829	6 ± 30 [0 (-100; 100)]	14 ± 37 [0 (-100; 150)]	0.127
	Getting around	43 ± 103 [0 (-100; 500)]	27 ± 57 [0 (-100; 300)]	0.900	5 ± 29 [0 (-100; 100)]	2 ± 20 [0 (-80; 100)]	0.247
	Self-care	5 ± 24 [0 (0; 133)]	-1 ± 20 [0 (-100; 75)]	0.343	-1 ± 17 [0 (-100; 50) ]	0 ± 0 [0 (0; 0)]	1.000
	Getting along withpeople	69 ± 138 [25 (-100; 800)]	38 ± 66 [0 (-100; 200)]	0.317	37 ± 58 [17 (0; 200)]	25 ± 47 [0 (-100; 100)]	0.322
	Life activities	8 ± 47 [0 (-100; 150)]	59 ± 104 [0 (-100; 400)]	0.008	39 ± 96 [0 (-100; 350)]	101 ± 174 [0 (-100; 800)]	0.046
	Participation insociety	72 ± 66 [69 (-100; 240)]	91 ± 112 [60 (-50; 550)]	0.593	77 ± 156 [37 (-17; 799)]	29 ± 51 [20 (-100; 200)]	0.044
	Total	74 ± 85 [58 (-100; 400)]	92 ± 123 [44 (-12; 635)]	0.500	72 ± 74 [50 (-25; 301)]	51 ± 66 [41 (-100; 349)]	0.453
SF-36	Physical function	-4 ± 7 [-4 (-24; 15)]	-5 ± 9 [0 (-44; 3)]	0.664	-1 ± 4 [0 (-24; 7)]	1 ± 9 [0 (-11; 65)]	0.237
	Physical role	-7 ± 34 [0 (-50; 101)]	-10 ± 26 [0 (-50; 101)]	0.833	0 ± 13 [0 (-50; 33)]	1 ± 19 [0 (-50; 101)]	0.894
	Bodily pain	-14 ± 15 [-18 (-40; 35)]	-15 ± 13 [-11 (-53; 11)]	0.842	-3 ± 9 [0 (-31; 22)]	0 ± 12 [0 (-27; 68)]	0.456
	General health	-15 ± 12 [-14 (-36; 16)]	-16 ± 11 [-14 (-50; 0)]	0.655	-3 ± 5 [-0 (-22; 7)]	-4 ± 5 [0 (-18; 8)]	0.766
	PCS	-8 ± 11 [-6 (-27; 32)]	-11 ± 11 [-8 (-45; 7)]	0.465	3 ± 9 [1 (-30; 18)]	3 ± 8 [1 (-15; 27)]	0.911
	Vitality	-6 ± 11 [-7 (-22; 54)]	-7 ± 8 [-4 (-43; 5)]	0.414	-5 ± 7 [-4 (-21; 6)]	-4 ± 13 [-2 (-28; 70)]	0.760
	Social function	-13 ± 20 [-15 (-40; 61)]	-21 ± 16 [-19 (-47; 18)]	0.090	-14 ± 15 [-12 (-53; 18)]	-14 ± 19 -13 (-59; 61)]	0.615
	Emotional role	-15 ± 50 [0 (-57; 133)]	-15 ± 34 [0 (-57; 133)]	0.447	-14 ± 23 [0 (-57; 23)]	-7 ± 44 [0 (-57; 133)]	0.832
	Mental health	-8 ± 18 [-11 (-33; 91)]	-10 ± 10 [-7 (-33; 4)]	0.613	-8 ± 11 [-6 (-31; 7)]	-5 ± 19 [-5 (-36; 115)]	0.674
	MCS	-14 ± 27 [-16 (-44; 123)]	-15 ± 16 [-10 (-51; 25)]	0.542	-17 ± 18 [-6 (-61; 2)]	-14 ± 28 [-8 (-62; 124)]	0.955

Cells represent the mean ± SD [median (minimum-maximum)] of the percentage change in score between the preoperative value and the postoperative value at 15-18 mo for each subject. WHODAS-II: World Health Organization Disability Assessment Schedule II; SF-36: 36-item Short Form Survey; PCS: Physical component score; MCS: Mental component score.

Table 5 Evaluation of the Ankara University Life Standards Questionnaire according to the type of surgery

	Patient				Spouse
Questions	APR	LAR	AR	P value	APR	LAR	AR	P value
General health status¹	0.58 ± 0.97 [1 (-2; 2)]	0.75 ± 0.51 [1 (0; 2)]	0.18 ± 0.72 [0 (-2; 2)]	0.002	0.42 ± 0.66 [0 (0; 2)]	0.66 ± 0.75 [1 (-1; 2)]	0.15 ± 0.44 [0 (-1; 1)]	0.006
General quality of life¹	0.76 ± 0.71 [1 (-1; 2)]	0.81 ± 0.59 [1 (0; 2)]	0.50 ± 0.66 [0 (0; 2)]	0.068	0.48 ± 0.71 [0 (-1; 2)]	1.06 ± 0.84 [1 (0; 3)]	0.32 ± 0.77 [0 (-2; 2)]	0.001
Time to return to old life and activity (mo)²	4.17 ± 1.37 [5 (0; 5)]	4.03 ± 1.52 [5 (0; 5)]	3.70 ± 1.16 [4 (1; 5)]	0.077	4.07 ± 1.14 [4 (0; 5)]	3.57 ± 1.75 [4 (0; 5)]	3 ± 1.53 [3 (0; 5)]	0.018
Amount of time spent with spouse³
Unchanged	6 (18.2)	10 (31.3)	21 (61.8)		5 (15.2)	5 (15.6)	22 (64.7)
Decreased	8 (24.2)	-	8 (23.5)		4 (12.1)	1 (3.1)	5 (14.7)
Increased	19 (57.6)	22 (68.8)	5 (14.7)	< 0.001	24 (72.7)	26 (81.3)	7 (20.6)	< 0.001
Amount of time spent at home³
Unchanged	5 (15.2)	8 (25)	26 (76.5)		4 (12.1)	4 (12.5)	21 (61.8)
Decreased	3 (9.1)	-	3 (8.8)	< 0.001	3 (9.1)	1 (3.1)	2 (5.9)	< 0.001
Increased	25 (75.8)	24 (75)	5 (14.7)		26 (78.8%)	27 (84.4)	11 (32.4)
Sex life³
Unchanged	13 (39.4)	18 (56.3)	32 (94.1)	< 0.001	20 (60.6)	19 (59.4)	31 (91.2)	0.005
Unavailable	20 (60.6)	14 (43.8)	2 (5.9)		13 (39.4)	13 (40.6)	3 (8.8)
Praying³
Unchanged	13 (46.4)	17 (68)	26 (100)	< 0.001	27 (96.4)	25 (96.2)	22 (100)	NA
Decreased	15 (53.6)	8 (32)	-		1 (3.6)	1 (3.8)	-
Fasting³
Unchanged	10 (35.7)	16 (64)	24 (92.3)	< 0.001	25 (89.3%)	25 (96.2)	22 (100)	NA
Decreased	18 (64.3)	79 (36)	2 (7.7)		3 (10.7)	1 (3.8)	-
Purifying aims³
Unchanged	22 (78.6)	18 (72)	25 (96.2)	0.064	27 (96.4)	25 (96.2)	22 (100)	NA
Decreased	6 (21.4)	7 (28)	1 (3.8)		1 (3.6)	1 (3.8)	-

¹Cells represent the mean ± SD [median (minimum-maximum)] of the percentage change in score between the preoperative value and the postoperative value at 15-18 mo- for each subject.

²mean ± SD [median (minimum-maximum)].

³Frequency (percent).

APR: Abdominoperineal resection; LAR: Low anterior resection; AR: Anterior resection.

Citation: Aylaz G, Akyol C, Kocaay AF, Gökmen D, Yavuzarslan AB, Erkek AB, Kuzu MA. Quality of life after colorectal surgery: A prospective study of patients compared with their spouses. World J Gastrointest Surg 2021; 13(9): 1050-1062
URL: https://www.wjgnet.com/1948-9366/full/v13/i9/1050.htm
DOI: https://dx.doi.org/10.4240/wjgs.v13.i9.1050