The Kazakhstan cohort (Cohort1)
A total of 650 patients who underwent cholecystectomy between 2013 and 2015 in Kazakhstan were identified. Inclusion criteria were complete citizen data (passport data, residential address and contact information), age over 18 years, diagnosis of acute or chronic cholecystitis and history of LCE and MCE. Exclusion criteria were incomplete citizen data or age under 18 years.
The patient survey was conducted 2016 - 2017. The telephone directory was used to obtain the phone numbers of all 650 patients. Each patient was rung up and asked to consent to participate in the survey after a detailed explanation of the goals and importance of the survey, and also their address of residence. A questionnaire, a cover letter, and a stamped addressed envelope were sent by post. Some patients agreed to be interviewed by telephone.
Of the 650 invited participants, 259 (39.8%) replied. Of these, 88 (34%) answered by post and 171(66%) by phone. The time interval between surgery and the survey ranged from 0.7 to 4.1 years. There were 183 (70.7%) women and 76 (29.3%) men. Mean age was 51.7 years, standard deviation 13.3 years. Most patients (128, 49.3%) were between 41 years and 60 years (Table 1).
There were 145 (56%) laparoscopic and 114 (44%) mini-laparatomy cholecystectomies. Histopathological examination showed chronic calculous cholecystitis (CCC) in 44 (17.0%) cases and acute calculous cholecystitis (ACC) in 215 (83.0%) cases. Procedures were undertaken after emergency admission in 176 (68.0%) cases, and planned admission in 83 (32.0%) cases.
TheSwedish cohort (Cohort II)
The cohort was extracted from the local database in Mora, Sweden. It included 448 patients who had undergone CE between February 1, 2002 and December 26, 2004, and who were 20 years-of-age and older. All patients were asked to answer a questionnaire sent by mail. The survey of patients was conducted between February 21, 2007 and December 14, 2008.
Of the 448 patients who underwent CE, 325 (72.5%) were women and 123 (27.5%) men. The age of the responders ranged from 21 years to 76 years. Mean age was 51.8 years (standard deviation 13.3 yrs). Patients were divided into two groups according to diagnosis: chronic cholecystitis or pain attacks 307 (68.5%); and acute cholecystitis 141 (31.5%). Altogether 368 (82.1%) patients underwent planned surgery, 78 (17.4%) patients were admitted as an emergency, and 2 (0.4%) patients were not specified. Altogether 388 (86.6%) underwent LCE.
The GIQLI questionnaire
Patients in Cohort 1 were requested to answer the GIQLI questionnaire in 2016. According to the recommendations of the MAPI Research Trust (Lyon, France)5 we validated this questionnaire for the first time in Kazakhstan and received official permission to use it. The GIQLI questionnaire is a recognised and valid tool for evaluating QL in patients with various gastrointestinal diseases and is widely used for evaluating QL in patients with gallstone disease.
The GIQLI questionnaire consists of 36 items (each scored 0 – 4) covering the following domains: severity of gastrointestinal symptoms – Symptom (19 questions); emotional component - Emotion (5 questions); physical function - physical Function (7 questions); social function - Social Function (4 questions); and response to treatment - Medical Treatment (1 question). The total GIQLI score assessment is performed by calculating the sum of all points for all items. The domains are analysed by summing the scores in a similar manner. A comparison was made regarding the general characteristics of the two cohorts (Table 2) 6.
In Cohort II, patients with chronic cholecystitis and/or pain attacks predominated. The proportion of planned patients and laparoscopic operations was slightly higher than in Cohort I. Since there were differences between the two groups for several of the parameters, comparison of QoL indicators was carried out for the cohort as a whole and then stratified surgical approach, mode of admission, and nature of gallbladder inflammation.
Statistical processing of the results was performed using SPSS Statistics 20.0 (IBM). For each quantitative indicator, the mean value (M), standard deviation (SD), and 95% confidence interval (CI) were calculated. The normality of the distribution was evaluated using the Kolmogorov-Smirnov test, and statistical calculations were performed using variance analysis (ANOVA) and the nonparametric Wilcoxon-Mann-Whitney test (WMW). A p-value <0.05 was considered statistically significant.