Discipline of Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia.
Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
Dis Esophagus. 2019 Aug 1;32(8). doi: 10.1093/dote/doz025.
Antireflux surgery aims to improve quality of life. However, whether patients and clinicians agree on what this means, and what is an acceptable outcome following fundoplication, is unknown. This study used clinical scenarios pertinent to laparoscopic fundoplication for gastroesophageal reflux to define acceptable outcomes from the perspective of patients, surgeons, and general practitioners (GPs). Patients who had previously undergone a laparoscopic fundoplication, general practitioners, and esophagogastric surgeons were invited to rank 11 clinical scenarios of outcomes following laparoscopic fundoplication for acceptability. Clinicopathological and practice variables were collated for patients and clinicians, respectively. GPs and esophagogastric surgeons additionally were asked to estimate postfundoplication outcome probabilities. Descriptive and multivariate statistical analyses were undertaken to examine for associations with acceptability. Reponses were received from 331 patients (36.4% response rate), 93 GPs (13.4% response), and 60 surgeons (36.4% response). Bloating and inability to belch was less acceptable and dysphagia requiring intervention more acceptable to patients compared to clinicians. On regression analysis, female patients found bloating to be less acceptable (OR: 0.51 [95%CI: 0.29-0.91]; P = 0.022), but dysphagia more acceptable (OR: 1.93 [95%CI: 1.17-3.21]; P = 0.011). Postfundoplication estimation of reflux resolution was higher and that of bloating was lower for GPs compared to esophagogastric surgeons. Patients and clinicians have different appreciations of an acceptable outcome following antireflux surgery. Female patients are more concerned about wind-related side effects than male patients. The opposite holds true for dysphagia. Surgeons and GPs differ in their estimation of event probability for patient recovery following antireflux surgery, and this might explain their differing considerations of acceptable outcomes.
抗反流手术旨在提高生活质量。然而，患者和临床医生是否就这意味着什么以及胃食管反流腹腔镜胃底折叠术后的可接受结果达成共识尚不清楚。本研究使用与腹腔镜胃底折叠术治疗胃食管反流相关的临床场景，从患者、外科医生和全科医生（GP）的角度定义了腹腔镜胃底折叠术后可接受的结果。先前接受过腹腔镜胃底折叠术的患者、全科医生和食管胃外科医生被邀请对 11 种腹腔镜胃底折叠术后的临床结果进行可接受性排名。分别收集了患者和临床医生的临床病理和实践变量。全科医生和食管胃外科医生还被要求估计胃底折叠术后的结果概率。进行了描述性和多变量统计分析，以检查与可接受性的关联。收到了 331 名患者（36.4%的回复率）、93 名全科医生（13.4%的回复率）和 60 名外科医生（36.4%的回复率）的回复。与临床医生相比，患者认为腹胀和无法打嗝的结果不太可接受，需要干预的吞咽困难的结果更可接受。回归分析显示，女性患者认为腹胀的结果不太可接受（OR：0.51[95%CI：0.29-0.91]；P=0.022），但吞咽困难的结果更可接受（OR：1.93[95%CI：1.17-3.21]；P=0.011）。与食管胃外科医生相比，全科医生术后估计反流缓解的概率更高，估计腹胀的概率更低。患者和临床医生对抗反流手术后的可接受结果有不同的看法。女性患者比男性患者更关注与风有关的副作用。吞咽困难则相反。外科医生和全科医生对患者接受抗反流手术后恢复事件的概率估计不同，这可能解释了他们对可接受结果的不同考虑。
