Health Related Quality of Life of Patients With Abdominal Wall Defects

Data of all patients with a congenital abdominal wall defect (CAWD) undergoing surgical repair between 1996 and 2011 in the Department of Pediatric Surgery of the Clinic for General Surgery, Visceral, Vascular and Pediatric Surgery of the Saarland University Medical Center in Homburg were retrieved from surgical health records. Up to 2001 these records were paper based and later on electronically available (SAP enhancement package 7 for SAP ERP 6.0: 2013, Walldorf, Germany). Except epidemiological data the type of disease, data concerning birth details, pre- and postnatal course, treatment, weight and growth development have been collected electronically.

Gastroschisis or omphalocele can be simple or complex. The investigators defined complex as involvement of stenosis, atresia, ischemia, volvulus or perforation, closed or vanishing gastroschisis, and chromosomal anomalies. Giant omphalocele was considered as complex as well. The type of the primary operative procedure, primary closure of the defect or other (patch plastic etc.), was also noted. The implementation of silo technique with delayed primary closure was regarded as primary closure.

A prospective analysis was conducted by a survey with age-related questionnaires to investigate the patient´s HrQoL. The study protocol was approved by the ethical board of Aerztekammer of Saarland (Nr. 206/2013). Informed consent was given by all participating patients or their guardians.

The data collection was carried out by telephone interview, personal interview or by regular mail. The interview was always conducted by the same person, a medical student (KK). The data was collected using age related questionnaires. Together with the collection of clinical data the investigators used the validated questionnaires KINDL, SDQ and SF-36.

The KINDL questionnaire (www.KINDL.org) is a specifically developed questionnaire for children, which was developed to assess the HrQoL of life of children and adolescents. The reference values were published as part of the study "The Children and Youth Health Survey (KIGGS)" by the Robert Koch Institute, Berlin, Germany and covers the health data of 17.641 children and adolescents in Germany aged 0-17 years.

The SDQ (Strengths and Difficulties Questionnaire) is the second questionnaire that was used. The investigators used the Woerner adjustment of the SDQ as it was transferred to a German cohort.

Since there are also some adult patients in the patient collective, the investigators have also integrated the SF-36, which was developed for adolescents and adult patients.

The SF-36 is an internationally recognized and widely used questionnaire for the assessment of health-related quality of life. It records eight different dimensions (= subscales) of quality of life: physical functioning, physical role function, pain, general health perception, vitality, social functioning, emotional role function and psychological well-being. Additionally, the overall physical sum score and overall psychological sum score are listed. German reference values are available as a reference for the SF-36.

In addition, disease specific questions were asked. These included somatic and clinical data about gastrointestinal function, cosmetic aspects and scars, problems during pregnancy of the child, actual clinical health status and psycho-social development. Answers were given as precise numbers or rated according to the following LIKERT-scale with these possibilities "never-seldom-sometimes-often-always".

All data were collected and processed in an Excel spreadsheet (Microsoft® Excel®, Microsoft Corporation, Redmond, Washington, USA). The statistical analysis was carried out with SPSS (IBM® SPSS® Statistics, Version 25, International Business Machines Corporation (IBM), Armonk, New York, USA) and Excel as well.