Advertisement

Long-term bowel dysfunction and decision regret in diverticulitis: A mixed methods study

Published:August 01, 2022DOI:https://doi.org/10.1016/j.surg.2022.04.051

      Abstract

      Background

      This study had aimed to describe long-term decision regret, bowel dysfunction, and the overall quality of life in patients with diverticulitis, and to determine if elective colectomy was associated with these patient-reported outcome measures.

      Methods

      This mixed-methods, survey-based study was administered to a national cohort of patients in the United States with diverticulitis. We measured decision regret (Brehaut Decision Regret), bowel dysfunction (Low Anterior Resection Syndrome score), and the overall quality of life (EuroQol 5 Dimension) in this population. We asked open-ended questions to elucidate factors that influenced patients’ choices between elective colectomy and observation.

      Results

      Among the 614 respondents, 294 (48%) chose between colectomy and observational management, 94 (15%) had surgery, and 157 (26%) had major Low Anterior Resection Syndrome. Of the 294 that chose between colectomy and observational management, 51 (17%) experienced decision regret. Colectomy was associated with an average decrease in the Brehaut Decision Regret score by 6 points but was not associated with a categorical measure of decision regret (Brehaut Score ≥50). Bowel dysfunction and overall quality of life were not significantly associated with colectomy. Disease-related factors, psychosocial factors, and interactions with physicians were commonly cited as reasons for pursuing colectomy or observational management.

      Conclusion

      Patients with self-reported diverticulitis describe high levels of decision regret and bowel dysfunction regardless of chosen management strategy. Physicians should be aware that psychosocial factors can strongly influence a patient’s choice between colectomy and observational management. We advocated for future prospective studies using patient reported outcome metrics to improve outcomes in diverticulitis.

      Graphical abstract

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Peery A.F.
        • Crockett S.D.
        • Murphy C.C.
        • et al.
        Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018.
        Gastroenterology. 2019; 156: 254-272.e211
        • Hall J.
        • Hardiman K.
        • Lee S.
        • et al.
        The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis.
        Dis Colon Rectum. 2020; 63: 728-747
        • Hawkins A.T.
        • Rothman R.L.
        • Geiger T.M.
        • et al.
        Patient-reported outcome measures in colon and rectal surgery: a systematic review and quality assessment.
        Dis Colon Rectum. 2020; 63: 1156-1167
        • Harris P.A.
        • Scott K.W.
        • Lebo L.
        • Hassan N.
        • Lightner C.
        • Pulley J.
        ResearchMatch: a national registry to recruit volunteers for clinical research.
        Acad Med. 2012; 87: 66-73
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inform. 2019; 95103208
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research Electronic Data Capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • Brehaut J.C.
        • O'Connor A.M.
        • Wood T.J.
        • et al.
        Validation of a decision regret scale.
        Med Decis Making. 2003; 23: 281-292
        • Wee C.C.
        • Fleishman A.
        • McCarthy A.C.
        • Hess D.T.
        • Apovian C.
        • Jones D.B.
        Decision regret up to 4 years after gastric bypass and gastric banding.
        Obes Surg. 2019; 29: 1624-1631
        • Becerra Perez M.M.
        • Menear M.
        • Brehaut J.C.
        • Legare F.
        Extent and predictors of decision regret about health care decisions: a systematic review.
        Med Decis Making. 2016; 36: 777-790
        • Emmertsen K.J.
        • Laurberg S.
        Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer.
        Ann Surg. 2012; 255: 922-928
        • Al-Saidi A.M.A.
        • Verkuijl S.J.
        • Hofker S.
        • Trzpis M.
        • Broens P.M.A.
        How should the low anterior resection syndrome score be interpreted?.
        Dis Colon Rectum. 2020; 63: 520-526
        • Herdman M.
        • Gudex C.
        • Lloyd A.
        • et al.
        Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).
        Qual Life Res. 2011; 20: 1727-1736
        • Pickard A.S.
        • Law E.H.
        • Jiang R.
        • et al.
        United States valuation of EQ-5D-5L health states using an international protocol.
        Value Health. 2019; 22: 931-941
        • Bayliss E.A.
        • Ellis J.L.
        • Steiner J.F.
        Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument.
        Health Qual Life Outcomes. 2005; 3: 51
        • Peters M.
        • Kelly L.
        • Potter C.M.
        • et al.
        Quality of life and burden of morbidity in primary care users with multimorbidity.
        Patient Relat Outcome Meas. 2018; 9: 103-113
        • Harrell Jr., F.E.
        • Dupont C.
        Harrell miscellaneous: a package of miscellaneous R functions.
        https://cran.r-project.org/web/packages/Hmisc/Hmisc.pdf
        Date: 2020
        Date accessed: February 24, 2021
        • van Buuren S.
        • Groothuis-Oudshoorn K.
        Mice: multiple imputation by chained equations in R.
        J Stat Software. 2011; 45: 1-67
        • Gauthier J.
        • Wu Q.V.
        • Gooley T.A.
        Cubic splines to model relationships between continuous variables and outcomes: a guide for clinicians.
        Bone Marrow Transplant. 2020; 55: 675-680
        • Schwarzer G.
        Meta: an R package for meta-analysis.
        R News. 2007; 7: 40-45
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials revisited.
        Contemp Clin Trials. 2015; 45: 139-145
        • Cochran W.G.
        The comparison of percentages in matched samples.
        Biometrika. 1950; 37: 256-266
        • Boeije H.
        A purposeful approach to the constant comparative method in the analysis of qualitative interviews.
        Quality and Quantity. 2002; 36: 391-409
        • Braun V.
        • Clarke V.
        What can "thematic analysis" offer health and wellbeing researchers?.
        Int J Qual Stud Health Well-being. 2014; 926152
        • Lin M.
        • Raman S.R.
        Evaluation of quality of life and surgical outcomes for treatment of diverticular disease.
        Clin Colon Rectal Surg. 2018; 31: 251-257
        • Forgione A.
        • Guraya S.Y.
        Elective colonic resection after acute diverticulitis improves quality of life, intestinal symptoms and functional outcome: experts' perspectives and review of literature.
        Updates Surg. 2016; 68: 53-58
        • Cohan J.N.
        • Orleans B.
        • Brecha F.S.
        • et al.
        Factors associated with decision regret among patients with diverticulitis in the elective setting.
        J Surg Res. 2021; 261: 159-166
        • Goldwag J.L.
        • Lyn R.V.
        • Wilson L.R.
        • Wilson M.Z.
        • Ivatury S.J.
        Effect of elective sigmoidectomy for diverticulitis on bowel function patient-reported outcomes.
        J Surg Res. 2019; 241: 135-140
        • Pasternak I.
        • Wiedemann N.
        • Basilicata G.
        • Melcher G.A.
        Gastrointestinal quality of life after laparoscopic-assisted sigmoidectomy for diverticular disease.
        Int J Colorectal Dis. 2012; 27: 781-787
        • Forgione A.
        • Leroy J.
        • Cahill R.A.
        • et al.
        Prospective evaluation of functional outcome after laparoscopic sigmoid colectomy.
        Ann Surg. 2009; 249: 218-224
        • van de Wall B.J.
        • Draaisma W.A.
        • van Iersel J.J.
        • Consten E.C.
        • Wiezer M.J.
        • Broeders I.A.
        Elective resection for ongoing diverticular disease significantly improves quality of life.
        Dig Surg. 2013; 30: 190-197
        • Justin V.
        • Uranues S.
        • Rabl H.
        • Fingerhut A.
        Quality of life in uncomplicated recurrent diverticulitis: surgical vs. conservative treatment.
        Sci Rep. 2020; 1010261
        • Santos A.
        • Mentula P.
        • Pinta T.
        • et al.
        Comparing laparoscopic elective sigmoid resection with conservative treatment in improving quality of life of patients with diverticulitis: the laparoscopic elective sigmoid resection following diverticulitis (LASER) randomized clinical trial.
        JAMA Surg. 2021; 156: 129-136
        • Bolkenstein H.E.
        • Consten E.C.J.
        • van der Palen J.
        • et al.
        Long-term outcome of surgery versus conservative management for recurrent and ongoing complaints after an episode of diverticulitis: 5-year follow-up results of a multicenter randomized controlled trial (DIRECT-Trial).
        Ann Surg. 2019; 269: 612-620
        • Egger B.
        • Peter M.K.
        • Candinas D.
        Persistent symptoms after elective sigmoid resection for diverticulitis.
        Dis Colon Rectum. 2008; 51: 1044-1048
        • Ambrosetti P.
        • Francis K.
        • Weintraub D.
        • Weintraub J.
        Functional results following elective laparoscopic sigmoidectomy after CT-proven diagnosis of acute diverticulitis evaluation of 43 patients and review of the literature.
        J Gastrointest Surg. 2007; 11: 767-772
        • Levack M.M.
        • Savitt L.R.
        • Berger D.L.
        • et al.
        Sigmoidectomy syndrome? Patients' perspectives on the functional outcomes following surgery for diverticulitis.
        Dis Colon Rectum. 2012; 55: 10-17
        • Kaser S.A.
        • Glauser P.M.
        • Basilicata G.
        • Muller D.A.
        • Maurer C.A.
        Timing of rectosigmoid resection for diverticular disease: the patient's view.
        Colorectal Dis. 2012; 14: e111-e116
        • Vicente P.
        • Reis E.
        Using questionnaire design to fight nonresponse bias in web surveys.
        Social Science Computer Review. 2010; 28: 251-267
        • Jin-Dominguez F.
        • Mansoor E.
        • Panhwar M.S.
        • et al.
        Epidemiology of diverticulitis and prevalence of first-ever colorectal cancer postdiverticulitis in adults in the United States: a population-based national study.
        Dis Colon Rectum. 2021; 64: 181-189
        • Joseph-Williams N.
        • Edwards A.
        • Elwyn G.
        The importance and complexity of regret in the measurement of 'good' decisions: a systematic review and a content analysis of existing assessment instruments.
        Health Expect. 2011; 14: 59-83
        • Masoni L.
        • Mari F.S.
        • Nigri G.
        • et al.
        Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial.
        Surg Endosc. 2013; 27: 199-206