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Factors affecting outcome and function in ostomates
S234
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
SURVEY QUESTION Problem was serious Patient was disabled Request was reasonable Doctor was helpful Satisfied with recommendation Liked patient/doctor
DR. RESPONSE: ORG–FNC
PT. RESPONSE: ORG–FNC
96%–4%* 92%–8%* 83%–17%* 72%–28% 68%–32% 77%–23%⫹
59%–41% 56%–44% 65%–35% 68%–32% 67%–33% 65%–35%
ORG vs FNC–*p⬍0.001, ⫹p⬍0.05
Conclusions: Doctors feel phone calls from patients with a functional diagnosis are less reasonable and their problems are less serious than patients with an organic diagnosis. In addition, they feel that functional pts are less disabled and less likable. There is no difference in patient attitudes with respect to FNC or ORG except that ORG pts feel they are more disabled. Further study is needed to understand the reasons for these different attitudes. 714 FACTORS AFFECTING OUTCOME AND FUNCTION IN OSTOMATES Joshua A. Katz, M.D., Helen Marquez, R.N., Argelia Welber, R.N., Jason Connor, Ph.D., Jonathan E. Efron, M.D., Juan J. Nogueras, M.D., Eric G. Weiss, M.D., Anthony M. Vernava, M.D. and Steven D. Wexner, M.D.*. Colorectal Surgery, Cleveland Clinic Florida, Weston, FL and Biostatistics, Cleveland Clinic Foundation, Cleveland, OH. Purpose: To investigate factors affecting quality of life and function in patients with stomas. Methods: 70 patients were studied. Patient demographics, diagnosis, stoma type, prognosis, timing of surgery, and status of preoperative stoma marking and discussion were recorded. Stoma appliance leak rate, and maximum and minimum wear time were recorded. The Fecal Incontinence Quality of Life (FIQOL) Scales (Lifestyle, Coping, Embarrassment, Depression) were determined. A stoma score was created and used to assess the anatomic qualities of the stoma during physical examination. Subgroup, correlation and linear modeling analysis was performed. Results: Increasing patient age and stoma age correlated with improved QOL indices. Increasing leak rate correlated with worsening stoma score, and worsening quality of life scores. Better stoma anatomy scores correlated with improved QOL scores, lower leak rate and longer appliance wear time. QOL scores were worse for temporary than for permanent stomas. Stomas marked preoperatively demonstrated better anatomic and QOL scores. Elective stomas were marked more frequently than emergent stomas and had better anatomic scores, lower leak rates, and improved QOL scores. Conclusions: Older patients may have higher QOL scores. QOL scores improve with stoma age. Preoperative marking and improved stoma anatomy scores correlate with stoma function and QOL scores.
Parameter Leak Rate Lifestyle QOL Coping QOL Embarrass QOL Stoma Score
Elective Stoma
Emergent Stoma
Wilcoxon P value
0.3⫾1.1 3.3⫾0.9 3.0⫾0.9 3.1⫾0.9 4.5⫾3.7
1.5⫾2.4 2.9⫾1.0 2.3⫾1.1 2.4⫾1.1 7.1⫾4.7
0.01 0.04 0.03 0.01 0.02
715 ABDOMINAL CT IN PRIMARY CARE OUTPATIENTS WITH ABDOMINAL PAIN Sonali S. Master, M.D., George F. Longstreth, M.D.* and Janis F. Yao, M.S. Gastroenterology, University of California, San Diego, San Diego, CA; Gastroenterology, Kaiser Permanente, San Diego, CA and Dept. of Research and Evaluation, Kaiser Permanente, Pasadena, CA.
Purpose: Abdominal pain is common in primary care and is caused by many functional and organic disorders. We investigated the effectiveness of abdominal computed tomography (CT) in the evaluation of primary care outpatients with abdominal pain in a large health maintenance organization. Methods: We identified 225 consecutive patients from radiology department records who had abdominal or abdominal/pelvic CT and reviewed their medical records. Inclusion criteria were age at least 18 years and CT ordered by a primary care physician for an outpatient with abdominal pain. Exclusion criteria were CT or specialty referral for the pain within 1 year, CT ordered due to another imaging abnormality, emergency department CT, and a known organic etiology for the pain. We assessed demographic, clinical and laboratory data (including warning signs; e.g., weight loss and anemia) and post–CT visits and imaging tests for abdominal pain. CT outcomes were: 1) positive, an abnormality diagnostic of the cause of the pain or that led directly to other diagnostic testing; 2) negative, normal or a nondiagnostic abnormality that led to no more imaging tests; 3) false positive, an abnormality that led to additional imaging but was not the cause of the pain; and 4) false negative, a normal report in a patient ultimately found to have an organic etiology in the imaged area (except disorders rarely shown on CT; e.g., peptic ulcers). Results: Eighty–six patients were studied. Their age (mean ⫾ SD) was 57.9 ⫾ 16.6 years; 47 (55%) were female. The pain duration was 7.3 ⫾ 14.8 months and post–CT follow– up was 26.8 ⫾ 12.0 months. There were no false negative reports. CT Outcomes, Warning Signs and Post–CT Medical Care Utilization
CT outcome Positive, n(%) Negative, n(%) False pos, n(%)
13 (15) 65 (76) 8 (9)
>1 Primary visit*
>1 Specialty visit**
>1 Imaging test**
>1 Warning sign**
2 (16) 12 (19) 3 (38)
7 (54) 21 (32) 7 (88)
6 (46) 31 (48) 7 (88)
12 (92) 20 (31) 2 (25)
*p⬍0.05, **p⬍0.01 (Fisher’s exact test)
Conclusions: 1) CT was diagnostic of the cause of abdominal pain in a small proportion of primary care outpatients. 2) Most patients with a positive CT had at least one warning sign. 3) False positive CT reports were over half as frequent as positive reports and more often led to primary care visits, specialty visits and imaging tests. 716 APPROPRIATENESS ASGE CRITERIA FOR COLONOSCOPY: THE INFLUENCE OF AGE ON THE PREDICTIVE VALUE Angelo Rossi, M.D., Gianluca Bersani, M.D., Giorgio Ricci, M.D., Giovanni De Fabritiis, M.D., Alessandra Suzzi, M.D., Beatrice Gorini, M.D. and Vittorio Alvisi, M.D.*. Endoscopia Digestiva Malatesta Novello, University of Ferrara, Cesena, FC, Italy. Purpose: The aim of this study was to evaluate the utility, assesed as predictive value, of ASGE appropriateness criteria to colonoscopy, in different classes of age of the patients ( ⬍⫽ 60 yrs, and ⬎ 60 yrs). Methods: We subdivided a cohort of 1790 consecutive patients (males 43%, mean age 60 yrs , range 17 – 97) referred for Colonoscopy to a University outpatients Clinic of North– eastern Italy, in two classes of age: 877 with age ⬍⫽ 60 yrs and 913 with age ⬎ 60 yrs. The percentage of patients who underwent Colonoscopy for appropriate and inappropriate indications, was prospectively assessed. The relationship between appropriateness of use and the presence of relevant endoscopic lesions (neoplasms, ulcers, ischemic colitis, diverticolitis inflammatory bowel disease, polyps, stenosis) was assessed calculating the likelihood ratio (positive, LR⫹ve and negative, LR–ve). The variation of the prevalence of relevant endoscopic lesions in the presence of the appropriateness of indications was also calculated using the Bayes theorem. Results: The observed rate of Colonoscopy generally not indicated was 35.2% and 38.1% respectively in the two classes of age (⬍⫽60 and ⬎60); furthermore the LR⫹ve, LR–ve and the variations of prevalence of relevant endoscopic lesions changed slightly among the groups (see Table).
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
SURVEY QUESTION Problem was serious Patient was disabled Request was reasonable Doctor was helpful Satisfied with recommendation Liked patient/doctor
DR. RESPONSE: ORG–FNC
PT. RESPONSE: ORG–FNC
96%–4%* 92%–8%* 83%–17%* 72%–28% 68%–32% 77%–23%⫹
59%–41% 56%–44% 65%–35% 68%–32% 67%–33% 65%–35%
ORG vs FNC–*p⬍0.001, ⫹p⬍0.05
Conclusions: Doctors feel phone calls from patients with a functional diagnosis are less reasonable and their problems are less serious than patients with an organic diagnosis. In addition, they feel that functional pts are less disabled and less likable. There is no difference in patient attitudes with respect to FNC or ORG except that ORG pts feel they are more disabled. Further study is needed to understand the reasons for these different attitudes. 714 FACTORS AFFECTING OUTCOME AND FUNCTION IN OSTOMATES Joshua A. Katz, M.D., Helen Marquez, R.N., Argelia Welber, R.N., Jason Connor, Ph.D., Jonathan E. Efron, M.D., Juan J. Nogueras, M.D., Eric G. Weiss, M.D., Anthony M. Vernava, M.D. and Steven D. Wexner, M.D.*. Colorectal Surgery, Cleveland Clinic Florida, Weston, FL and Biostatistics, Cleveland Clinic Foundation, Cleveland, OH. Purpose: To investigate factors affecting quality of life and function in patients with stomas. Methods: 70 patients were studied. Patient demographics, diagnosis, stoma type, prognosis, timing of surgery, and status of preoperative stoma marking and discussion were recorded. Stoma appliance leak rate, and maximum and minimum wear time were recorded. The Fecal Incontinence Quality of Life (FIQOL) Scales (Lifestyle, Coping, Embarrassment, Depression) were determined. A stoma score was created and used to assess the anatomic qualities of the stoma during physical examination. Subgroup, correlation and linear modeling analysis was performed. Results: Increasing patient age and stoma age correlated with improved QOL indices. Increasing leak rate correlated with worsening stoma score, and worsening quality of life scores. Better stoma anatomy scores correlated with improved QOL scores, lower leak rate and longer appliance wear time. QOL scores were worse for temporary than for permanent stomas. Stomas marked preoperatively demonstrated better anatomic and QOL scores. Elective stomas were marked more frequently than emergent stomas and had better anatomic scores, lower leak rates, and improved QOL scores. Conclusions: Older patients may have higher QOL scores. QOL scores improve with stoma age. Preoperative marking and improved stoma anatomy scores correlate with stoma function and QOL scores.
Parameter Leak Rate Lifestyle QOL Coping QOL Embarrass QOL Stoma Score
Elective Stoma
Emergent Stoma
Wilcoxon P value
0.3⫾1.1 3.3⫾0.9 3.0⫾0.9 3.1⫾0.9 4.5⫾3.7
1.5⫾2.4 2.9⫾1.0 2.3⫾1.1 2.4⫾1.1 7.1⫾4.7
0.01 0.04 0.03 0.01 0.02
715 ABDOMINAL CT IN PRIMARY CARE OUTPATIENTS WITH ABDOMINAL PAIN Sonali S. Master, M.D., George F. Longstreth, M.D.* and Janis F. Yao, M.S. Gastroenterology, University of California, San Diego, San Diego, CA; Gastroenterology, Kaiser Permanente, San Diego, CA and Dept. of Research and Evaluation, Kaiser Permanente, Pasadena, CA.
Purpose: Abdominal pain is common in primary care and is caused by many functional and organic disorders. We investigated the effectiveness of abdominal computed tomography (CT) in the evaluation of primary care outpatients with abdominal pain in a large health maintenance organization. Methods: We identified 225 consecutive patients from radiology department records who had abdominal or abdominal/pelvic CT and reviewed their medical records. Inclusion criteria were age at least 18 years and CT ordered by a primary care physician for an outpatient with abdominal pain. Exclusion criteria were CT or specialty referral for the pain within 1 year, CT ordered due to another imaging abnormality, emergency department CT, and a known organic etiology for the pain. We assessed demographic, clinical and laboratory data (including warning signs; e.g., weight loss and anemia) and post–CT visits and imaging tests for abdominal pain. CT outcomes were: 1) positive, an abnormality diagnostic of the cause of the pain or that led directly to other diagnostic testing; 2) negative, normal or a nondiagnostic abnormality that led to no more imaging tests; 3) false positive, an abnormality that led to additional imaging but was not the cause of the pain; and 4) false negative, a normal report in a patient ultimately found to have an organic etiology in the imaged area (except disorders rarely shown on CT; e.g., peptic ulcers). Results: Eighty–six patients were studied. Their age (mean ⫾ SD) was 57.9 ⫾ 16.6 years; 47 (55%) were female. The pain duration was 7.3 ⫾ 14.8 months and post–CT follow– up was 26.8 ⫾ 12.0 months. There were no false negative reports. CT Outcomes, Warning Signs and Post–CT Medical Care Utilization
CT outcome Positive, n(%) Negative, n(%) False pos, n(%)
13 (15) 65 (76) 8 (9)
>1 Primary visit*
>1 Specialty visit**
>1 Imaging test**
>1 Warning sign**
2 (16) 12 (19) 3 (38)
7 (54) 21 (32) 7 (88)
6 (46) 31 (48) 7 (88)
12 (92) 20 (31) 2 (25)
*p⬍0.05, **p⬍0.01 (Fisher’s exact test)
Conclusions: 1) CT was diagnostic of the cause of abdominal pain in a small proportion of primary care outpatients. 2) Most patients with a positive CT had at least one warning sign. 3) False positive CT reports were over half as frequent as positive reports and more often led to primary care visits, specialty visits and imaging tests. 716 APPROPRIATENESS ASGE CRITERIA FOR COLONOSCOPY: THE INFLUENCE OF AGE ON THE PREDICTIVE VALUE Angelo Rossi, M.D., Gianluca Bersani, M.D., Giorgio Ricci, M.D., Giovanni De Fabritiis, M.D., Alessandra Suzzi, M.D., Beatrice Gorini, M.D. and Vittorio Alvisi, M.D.*. Endoscopia Digestiva Malatesta Novello, University of Ferrara, Cesena, FC, Italy. Purpose: The aim of this study was to evaluate the utility, assesed as predictive value, of ASGE appropriateness criteria to colonoscopy, in different classes of age of the patients ( ⬍⫽ 60 yrs, and ⬎ 60 yrs). Methods: We subdivided a cohort of 1790 consecutive patients (males 43%, mean age 60 yrs , range 17 – 97) referred for Colonoscopy to a University outpatients Clinic of North– eastern Italy, in two classes of age: 877 with age ⬍⫽ 60 yrs and 913 with age ⬎ 60 yrs. The percentage of patients who underwent Colonoscopy for appropriate and inappropriate indications, was prospectively assessed. The relationship between appropriateness of use and the presence of relevant endoscopic lesions (neoplasms, ulcers, ischemic colitis, diverticolitis inflammatory bowel disease, polyps, stenosis) was assessed calculating the likelihood ratio (positive, LR⫹ve and negative, LR–ve). The variation of the prevalence of relevant endoscopic lesions in the presence of the appropriateness of indications was also calculated using the Bayes theorem. Results: The observed rate of Colonoscopy generally not indicated was 35.2% and 38.1% respectively in the two classes of age (⬍⫽60 and ⬎60); furthermore the LR⫹ve, LR–ve and the variations of prevalence of relevant endoscopic lesions changed slightly among the groups (see Table).