Abdominal Surgery Impact Scale (ASIS) is Responsive in Assessing Outcome Following IPAA

Various generic and disease-specific quality of life instruments are available to assess outcome following surgery. However, they may not be sensitive to changes in outcome in the early postoperative period, which is important when assessing changes in surgical technique and perioperative care. The Abdominal Surgery Impact Scale (ASIS) is a validated instrument designed to assess short-term outcome following surgery. Thus, the aims of this study were to assess the impact of surgery on patients undergoing ileal pouch anal anastomosis (IPAA), assess factors which might impact on outcome, and lastly, further evaluate the reliability and internal consistency of the ASIS. Patients over the age of 18 who had an IPAA between March 2005 and October 2007 completed the ASIS on postoperative day 3 and at the time of discharge. The ASIS contains 18 items within six domains with possible scores ranging from 18 to 126. Demographic, clinical and surgical data, postoperative complications, and length of stay were also recorded. Internal reliability of the ASIS was measured using Cronbach's alpha coefficient. Ninety-two patients (36 female, 56 male, mean age = 36.8 +/- 10.8) completed the ASIS at two time intervals (mean 3 days and mean 7 days postoperatively). Forty-seven patients had an IPAA performed with an ileostomy; 11 patients had the IPAA performed laparoscopically. The mean hospital stay was 10.8 days. The overall mean ASIS score significantly increased over the two time periods (mean 56.9 +/- 18.3 vs. 81.8 +/- 17.3, p < 0.001). Patients who had an ileostomy had a significantly lower mean score at discharge (77.32 vs. 86.82), secondary to lower scores on the physical limitations, functional impairment, and visceral function domains. Seven (7.8%) patients had ileo-anal anastomotic leaks, and seven (7.8%) patients had small bowel obstructions. These patients had an increased length of stay, whereas patients having laparoscopic surgery had a significantly shorter length of stay (8.8 days vs. 11.1 days), but there was no significant difference in mean ASIS scores. Cronbach's alpha coefficient was 0.94 overall and ranged from 0.69 to 0.91 for subscales indicating internal reliability. ASIS is a valid instrument for measuring quality of life in the postoperative period and is responsive to changes over time. Although quality of life increases postoperatively during hospital stay, at discharge, patients with IPAA still have decreased quality of life. Patients with ileostomies have further decreased scores.