| Abstract |
Quality of Life (QOL) refers to an individual’s total wellbeing that includes all emotional, social, and physical aspects of life. However, when the phrase is used in reference to medicine and healthcare it refers to how the individual’s wellbeing may be impacted over time by a disease, a disability, or a disorder.
Morbid obesity affects quality of life. Its assessment has gained significant attention and it is obtained through specific measuring instruments as the Moorehead-Ardelt Quality of Life Questionnaire II (MAII). This is an obesity-specific instrument widely used in bariatric surgery that has been created and validated in the English language. According to current standards of validation studies, adapting questionnaires from one language to another should employ standardized methodology for translation and ensuring the retainment of psychometric properties. Therefore, a valid translation and assessment of the properties of the Hellenic version of MAII before its routine use in bariatric patients was deemed as necessary. This was achieved through cross-validation with the Greek version of SF-36 and a Visual Analogue Scale (VAS). Internal consistency was indicated by Cronbach’s alpha coefficient and test-retest reliability by intraclass correlation coefficient (ICC). Construct validity was studied using Pearson’s correlations between the MAII, the SF-36 and the VAS.
A total of 175 patients were enrolled in the study. Test-retest analysis was applied to 40 patients with a 15-day interval. A very good internal consistency with Cronbach’s alpha coefficient of 0.85 was shown. Excellent test-retest reliability was observed with an overall ICC of 0.981. Significant correlations between the Greek MAII and the other instruments as well as of each item of the MAII with the scores of SF-36 and the VAS indicated high construct and convergent validity. A negative correlation between the translated MAII total score and BMI confirmed high clinical validity.
After this thorough procedure the Greek version of the MAII questionnaire was generated and shown to be valid and reliable in measuring QΟL in morbidly obese patients before and after bariatric surgery.
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The second step of this study consisted of the clinical application of the translated questionnaire for the prospective longitudinal assessment of QOL in patients undergoing laparoscopic Sleeve Gastrectomy (LSG). QOL is considered a major bariatric outcome measure but prospective data of QOL changes after LSG are still poor in the literature.
Consecutive morbidly obese patients admitted for LSG, over a 30-month period were prospectively recruited. The MAII questionnaire and a 10-point VAS were offered to the patients preoperatively and at 6, 12 and 24 months postoperatively. Full somatometric and co-morbidities profile was recorded at all time points.
A total of 111 patients (60 females, 51 males, mean age 36.8±9.2 years) were included in the study. There was no mortality and the total complication rate was 15.3%. The mean preoperative BMI was 49.1±7.5kg/m2 and % excess BMI loss (%EBL) was 51.1±14.9% at 6, 64.2±17.9% at 12 and 66.4±18% at 24 months postoperatively. All obesity-related co-morbidities were significantly ameliorated. The mean MAII total score was -0.40±1.30 preoperatively and increased to 1.75±0.83, 2.18±0.80 and 1.95±0.71 at 6, 12 and 24 months postoperatively (p΄&λτ0.001). The VAS score increase from 2.8±1.4 preoperatively to 9.1±1.1, 9.2±1.1 and 9.0±1.3 at 6, 12 and 24 months postoperatively. The improvement in MAII score was more sustained in females at 24 months, although end BMI was comparable between the two genders. BMI was not directly correlated with MAII score at each time point. %EBL, female gender, reduced number of comorbidities and resolution of diabetes and sleep apnea were strong predictors of higher QOL at the end of the study, as resulted from multivariate linear regression and mixed effect model analysis. Interestingly, patients who had their diabetes resolved presented high values of QOL even though their %EBL was statistically lower.
LSG is a safe and effective bariatric operation with acceptable morbidity, satisfactory and sustained weight loss and significant improvement in QOL especially in patients with ameliorated comorbidities. The metabolic effect of bariatric surgery seems to be more important than weight-loss in terms of QOL improvement. The analysis of QOL is important for a complete bariatric outcome evaluation and allows the
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recognition of subgroups of patients that will benefit the most from the bariatric operation and of those who will need some form of intervention during follow up in order to maintain the optimal QOL outcome. The importance of the metabolic effect of LSG on QOL reveals interesting future paths for bariatric surgery.
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Μελέτη της ποιότητας ζωής πριν και μετά από χειρουργική αντιμετώπιση της νοσογόνου παχυσαρκίας
