Daliya, Prita
(2020)
Laparoscopic cholecystectomy: clinical and patient reported outcomes.
PhD thesis, University of Nottingham.
Abstract
Introduction:
Laparoscopic cholecystectomy is one of the commonest general surgical operations performed, yet little is known about its impact on patient and clinical outcomes in the UK (United Kingdom) population. Where available, existing processes for measuring outcomes are not readily accessible or unable to provide real-time information to end users. Despite technological advances, there have been no significant changes in improving the communication and data-sharing processes between patients and clinicians. The aims of this study were to use Hospital Episode Statistics (HES) data to identify the burden of disease leading to cholecystectomy in the UK population, help develop the patient-facing application aboutmyop.org and pilot its use in routine clinical care for patients undergoing elective laparoscopic cholecystectomy.
Methods:
An analysis of HES data on acute cholecystitis was used to identify the breadth of disease burden in the United Kingdom, and a systematic review of current patient reported outcome measures was performed to help identify appropriate surveys for measuring patient outcomes using a digital platform. The aboutmyop.org site was created with the expertise of EIDO Healthcare Ltd. and experts in web development through a government grant. In addition to national ethics application, the involvement of local information governance teams and patient advisory groups were used to develop site content and perform beta-testing. Clinical outcomes were measured by prospective audit, and the aboutmyop.org site was used to collect information on post-operative outcomes, and patient reported outcomes.
Results:
Whilst symptomatic gallstones remain a large burden in the UK population, HES data demonstrate that emergency cholecystectomy for acute cholecystitis risks overtreatment in 50% of the population. Consequently, patients with symptomatic gallstones identified for elective laparoscopic cholecystectomy or interval cholecystectomy were invited to participate in this study. A total of 898 patients were invited to use the aboutmyop.org system, but due to stringent security rules only 349 patients (38.9%) managed to complete the registration process for the aboutmyop.org site. The majority of participants were female (79.1%), with a mean age of 47.6 years (SD 14.9, IQR 35.2 – 58.8 years). Only 200 (57.3%) of all participants went on to undergo a laparoscopic cholecystectomy, and a small proportion of these completed their post-operative interactions; 7-day digital follow-up (42.5%), and post-operative ePROMs at 30-days (30.5%), 3-months (27.0%), and 6-months (19.0%).
Conclusion:
National data from HES emphasise the magnitude of the problem that gallstones have on the UK population. The aboutmyop.org system demonstrates a method to improve information accessibility for these patients and a novel method for collecting outcomes data, and data-sharing between patients and clinicians. Digital follow-up was identified as a safe alternative for laparoscopic cholecystectomy follow-up, and ePROMs demonstrated a significant improvement in quality of life in post cholecystectomy patients.
Whilst this feasibility study demonstrates a willingness for patients to engage in virtual recruitment and digital surveys utilising the aboutmyop.org system, further amendments and system improvements are necessary prior to mainstream use.
Actions (Archive Staff Only)
 |
Edit View |
Tools
Tools
![[thumbnail of DALIYA Thesis-270920_amendments removed.pdf]](https://eprints.nottingham.ac.uk/style/images/fileicons/application_pdf.png "DALIYA Thesis-270920_amendments removed.pdf")