Quality of life after surgery for Crohn's disease: A psychosocial survey

In an effort to assess the quality of life after surgery for Crohn's disease, we have conducted a psychosocial survey of patients who underwent their first elective operation at this institution 5-10 yr earlier. Of all 53 patients who qualified for study, 51 (96%) were located and interviewed. Twenty-six patients had their initial disease confined to the ileum; 25 had disease predominantly in the colon with or without concomitant ileal involvement. They were asked specific questions about disease-related problems in interpersonal relationships, school and job performance, recreational activity, sexuality, and body image. These five areas, as well as physical symptoms, general function, and overall satisfaction were assessed for three periods in time: 6 mo preoperatively, 1 yr postoperatively, and at interview. All 51 patients (100%) recalled impairment of overall function preoperatively, classified as severe by 20 patients with ileitis (77%) and 22 with (ileo)colitis (88%). The patients reported a progressive postoperative decrease in overall dysfunction, with the proportions describing impairment at the time of interview being only 42% (15% severe) with ileitis and 48% (12% severe) with (ileo)colitis. Similar improvement was also reported for physical symptoms and for each of the five psychosocial areas surveyed. Despite disease recurrence or extension in 27 patients, and the creation of an ileostomy in 14, 47 patients (92%) were satisfied with the surgical outcome; only 4 (8%) would not have chosen surgery again. Disease recurrence or an ileostomy were significantly unfavorable influences, yet did not prevent the reporting of substantial improvement compared to preoperative status. After elective surgery, therefore, most patients with Crohn's disease perceive the operation as having provided long-term improvement in their quality of life.