Oudhoff J P, Timmermans D R M, Knol D L, Bijnen A B, van der Wal G
Department of Public and Occupational Health, Institute for Research in Extramural Medicine, Free University Medical Centre, Amsterdam, The Netherlands.
BMC Public Health. 2007 Jul 19;7:164. doi: 10.1186/1471-2458-7-164.
Long waiting times for elective surgical treatment threaten timely care provision in several countries. The purpose of this study was to assess the impact of waiting for elective general surgery on the quality of life and psychosocial health of patients.
A cross-sectional questionnaire study with postoperative follow-up was performed among patients on waiting lists for surgical treatment of varicose veins (n = 176), inguinal hernia (n = 201), and gallstones (n = 128) in 27 hospitals.
In each group the waiting period involved worse general health perceptions (GHPQ), more problems in quality of life (EuroQoL), and raised levels of anxiety (STAI) as compared to after surgery (all differences: p < 0.05). Quality of life was not affected in 19-36% of patients. Emotional reactions to waiting were most negative among patients with gallstones. Prior information about the duration of the wait reduced the negativity of these reactions (p < 0.05). Social activities were affected in 39% to 48% of the patients and 18%-23% of employed patients reported problems with work during the wait. Having waited a longer time was associated with worse quality of life among patients with inguinal hernia. Longer waited times also engendered more negative reactions to waiting among patients with inguinal hernia and gallstones (multilevel regression analysis, p < 0.01).
Waiting for general surgery mainly involves a prolonged period of decreased health and an affected psychological and social life of the patient in waiting. Variation in the severity of these consequences across patients indicates that the prioritisation of patients could reduce the overall burden of waiting. Early information about the duration of the delay could further promote a patient's acceptance of waiting.
在一些国家，择期手术治疗的长时间等待威胁到了及时的医疗服务提供。本研究的目的是评估等待择期普通外科手术对患者生活质量和心理社会健康的影响。
在27家医院对静脉曲张（n = 176）、腹股沟疝（n = 201）和胆结石（n = 128）手术治疗等待名单上的患者进行了一项带有术后随访的横断面问卷调查研究。
与术后相比，每组患者的等待期都伴随着更差的总体健康感知（GHPQ）、更多的生活质量问题（欧洲生活质量量表）以及更高的焦虑水平（状态特质焦虑量表）（所有差异：p < 0.05）。19% - 36%的患者生活质量未受影响。胆结石患者对等待的情绪反应最为消极。关于等待时长的预先信息减少了这些反应的消极程度（p < 0.05）。39%至48%的患者社交活动受到影响，18% - 23%的在职患者报告在等待期间工作出现问题。腹股沟疝患者等待时间越长，生活质量越差。等待时间越长，腹股沟疝和胆结石患者对等待的消极反应也越多（多水平回归分析，p < 0.01）。
等待普通外科手术主要意味着患者健康状况下降的时间延长以及等待患者的心理和社会生活受到影响。这些后果在患者中的严重程度存在差异，这表明对患者进行优先排序可以减轻总体等待负担。关于延迟时长的早期信息可以进一步促进患者对等待的接受。
