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Am Fam Physician. 2003;68(10):2073-2074

Crohn's disease is characterized by asymptomatic periods with episodic worsening of symptoms. Treatment aims to decrease relapse rate and/or minimize symptoms. Successful treatment is measured by improved quality of life and reduced disruptions of daily routine. Most patients with Crohn's disease have at least one surgical procedure during their lifetime, and surgery increases the likelihood of requiring further surgery. However, the impact of surgery on quality of life may help patients make decisions about operations. Delaney and associates studied preoperative and postoperative quality of life in 82 patients who had surgery for Crohn's disease.

The authors used the Cleveland Global Quality of Life (CGQL) score, which has been validated in Crohn's disease. Participants completed the CGQL before surgery and again 30 days after the procedure. Surgery was elective in 78 of the patients. Postoperatively, major complications occurred in 19 patients (23 percent).

The CGQL showed significant improvement 30 days after surgery, with 54 patients showing improvement, eight showing no change, and 20 showing a worse CGQL score. Sixty-five patients said they would undergo surgery again if they were in a position to choose. Independent predictors of greater improvement in postoperative CGQL included female sex and absence of postoperative complications, while use of steroids at the time of surgery was associated with greater improvement.

The authors conclude that surgery improved quality of life in patients with active Crohn's disease or Crohn's disease in remission. The likelihood of positive outcomes increased among women and among those who did not have any postoperative complications, and was not affected by other patient characteristics, nature of disease, indication for surgery, procedure performed, or nature of complications. Many patients said they would choose surgery again if they had the choice.

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