The long-term effect of bile duct injuries on health-related quality of life: a meta-analysis

Abstract

Background: The reported effects of biliary injury on health-related quality of life (HRQOL) have varied widely. Meta-analysis methodology was applied to examine the collective findings of the long-term effect of bile duct injury (BDI) on HRQOL.

Methods: A comprehensive literature search was conducted in March, 2012. Because the HRQOL surveys differed among reports, BDI and uncomplicated laparoscopic cholecystectomy (LC) groups' HRQOL scores were expressed as effect sizes (ES) in relation to a common, general population, standard. A negative ES indicated a reduced HRQOL, with a substantive reduction defined as an ES ≤ -0.50. Weighted logistic regression tested the effects of BDI (versus LC) and follow-up time on whether physical and mental HRQOL were substantively reduced.

Results: Data were abstracted from six publications, which encompass all reports of HRQOL after BDI in the current, peer-reviewed literature. The analytic database comprised 90 ES computations representing 831 patients and 11 unique study groups (six BDI and five LC). After controlling for follow-up time (P ≤ 0.001), BDI patients were more likely to have reduced long-term mental [odds ratio (OR) = 38.42, 95% confidence interval (CI) = 19.14-77.10; P < 0.001] but not physical (P = 0.993) HRQOL compared with LC patients.

Discussion: This meta-analysis of findings from six peer-review reports indicates that, in comparison to LC, there is a long-term detrimental effect of BDI on mental HRQOL.

Figure 1

This figure illustrates the literature review and study inclusion process which resulted in six studies that represent all reports of health-rated quality of life (HRQOL) after bile duct injury (BDI) in the current, peer-reviewed literature. Weighted logistic regression models were then used to determine, after controlling for time post-cholecystectomy, the effect of BDI (with LC as the reference group) on the likelihood of physical (n = 44 observations) and mental (n = 46 observations) HRQOL being substantively reduced

Figure 2

The 90 individual effect size observations that comprised the meta-analytic database are depicted by primary publication and health-related quality of life (HRQOL) scale. These data illustrate the variability of HRQOL scales employed and the heterogeneity of outcomes reported across these studies. Observations that fall at or below the dashed line [effect sizes (ES) ≤ −0.5] were classified in the logistic regression models as representing substantively reduced HRQOL and those that fall above the dashed line were classified as representing HRQOL that was not reduced. Abbreviations for the Short Form 36 Health Survey® (SF-36) scales and components are: PF, physical functioning; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental health; PCS, physical component summary; MCS, mental component summary. The City of Hope (COH) scales are: phys, physical; psy, psychological; social, social. The psychological and social scales were considered mental HRQOL for the purpose of these analyses