This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Modelling the effect of venous disease on quality of life. BJS 2011; 98: 1089-1098.
Published: 20th May 2011
Authors: D. Carradice, F. A. K. Mazari, N. Samuel, V. Allgar, J. Hatfield, I. C. Chetter et al.
Background
A clear understanding of the relationship between venous reflux, clinical venous disease and the effects on quality of life (QoL) remains elusive. This study aimed to explore the impact of venous disease, and assess any incremental direct effect of progressive disease on health‐related QoL, with the ultimate aim to model venous morbidity.
Method
Consecutive patients with venous disease were assessed for inclusion in the study. Patients with isolated, unilateral, single superficial axial incompetence diagnosed on duplex imaging were included. Clinical grading was performed with the Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification and Venous Clinical Severity Score (VCSS). Patients completed generic (Short Form 36, SF‐36®; EuroQol 5D, EQ‐5D™) and disease‐specific (Aberdeen Varicose Vein Questionnaire, AVVQ) QoL instruments. Multivariable regression modelling was performed, taking account of demographic and anatomical factors, to explore the effect of clinical severity on QoL impairment.
Results
Some 456 patients with C2–6 venous disease were included, along with control data for 105 people with C0–1 disease. Increasing clinical grade corresponded strongly with deterioration in disease‐specific QoL (P < 0·001). This could be stratified into three distinguishable groups: C0–1, C2–4 and C5–6 (P < 0·001 to P = 0·006). Increasing clinical grade also corresponded with deterioration in the physical domains of SF‐36® (P < 0·001 to P = 0·016), along with EQ‐5D™ index utility (quality‐adjusted life year) scores (P < 0·001).
Conclusion
Demonstrable morbidity was seen, even with uncomplicated venous disease. The physical impairment seen with venous ulceration was comparable with that seen in congestive cardiac failure and chronic lung disease. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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