Nichols Thom R, Inglese Gary W
Hollister Inc., Libertyville, IL, USA.
Hollister Inc., Libertyville, IL, USA.
Value Health. 2018 Jan;21(1):89-94. doi: 10.1016/j.jval.2017.07.004. Epub 2017 Sep 1.
Body-altering surgery may affect perceptions of one's self. For those with abdominal stoma surgeries, altered perceptions amplified by peristomal skin condition can increase health burdens.
To assess health utility and health-related quality of life in an adult US ostomy sample in the presence of three levels of peristomal skin condition: intact, moderately compromised, and severely compromised.
The short form 36 health survey version 2, a generic health survey incorporating the six-dimensional health state short form preference-based utility index, was chosen to assess the sample. Analysis of covariance adjusted for age and time from surgery was used.
The six-dimensional health state short form utilities for those with intact skin and physical component summary (PCS) levels indicating no physical limitations varied significantly from those with severely compromised skin and indicating the greatest degree of physical limitation (0.833 vs. 0.527). Peristomal skin condition decreases were associated with health utility decreases across all levels of the PCS. Because peristomal skin conditions are intermittent, the analysis presents quality-adjusted life-days (QALDs) per month. Ostomates with intact skin and PCS levels indicating no physical limitations demonstrated significant differences from those with severe skin condition and indicating the greatest degree of physical limitations (26.5 d/mo vs. 15.8 d/mo). As peristomal skin condition worsened, QALDs decreased across all levels of the PCS. A minimally important expected value of health was estimated to be an increase of 2.18 QALDs/mo.
Successful treatment from a clinical perspective is more than the elimination of conditions-it is also a return of quality time to an individual.
身体改造手术可能会影响对自我的认知。对于接受腹部造口手术的患者，造口周围皮肤状况加剧的认知改变会增加健康负担。
评估美国成年造口样本在造口周围皮肤状况的三个水平（完好、中度受损和严重受损）下的健康效用和与健康相关的生活质量。
选择包含基于偏好的六维健康状态简表效用指数的通用健康调查问卷——健康调查简表第2版，对样本进行评估。采用协方差分析，并对年龄和手术时间进行校正。
皮肤完好且身体成分汇总（PCS）水平表明无身体限制者的六维健康状态简表效用，与皮肤严重受损且表明身体限制程度最大者的效用有显著差异（0.833对0.527）。在PCS的所有水平上，造口周围皮肤状况变差均与健康效用降低相关。由于造口周围皮肤状况是间歇性的，分析给出了每月的质量调整生命天数（QALD）。皮肤完好且PCS水平表明无身体限制的造口者，与皮肤状况严重且表明身体限制程度最大的造口者相比，有显著差异（26.5天/月对15.8天/月）。随着造口周围皮肤状况恶化，在PCS的所有水平上QALD均下降。估计健康的最小重要预期值为每月增加2.18个QALD。
从临床角度来看，成功的治疗不仅仅是消除病症，还意味着让个体重新拥有有质量的时间。
