Evaluating Patient Satisfaction and Quality of Life After Undergoing Laparoscopic Cholecystectomy in Al-Qunfudhah Governorate, Saudi Arabia

Background: Gallstone disease, commonly referred to as cholelithiasis, is a prevalent medical condition that has substantial global implications. Due to its numerous benefits, such as cheaper costs and shorter hospital stays, laparoscopic cholecystectomy (LC) has replaced open surgery as the most often performed surgical method for treating a range of biliary problems in wealthy countries. Any medical procedure's long-term patient well-being must be assessed, starting with the quality of life (QoL), patient satisfaction, and postoperative healing. Aim: The current study aims to evaluate patient satisfaction and QoL after undergoing LC in Al-Qunfudhah Governorate. Methods: A cross-sectional study was conducted targeting all patients who underwent LC in Al-Qunfudhah Governorate during the period from January to March 2024. The online survey was initiated by the study researchers after an intensive literature review and experts' consultation. The validated questionnaire was uploaded online using Google Forms and distributed electronically via social media apps. Results: The current study included records of 200 participants where the highest proportion falls within the 26 to 35 age group, comprising 57 individuals (28.5%). In terms of gender, males represent the majority, with 109 participants (54.5%). A total of 122 individuals (61.0%) reported being satisfied with their procedures. Conversely, 18 patients (9.0%) expressed dissatisfaction. The majority of participants under investigation expressed satisfaction with their overall QoL after undergoing LC, with 84 patients (42.0%) reporting satisfaction and 67 patients (33.5%) reporting being very satisfied. Additionally, only a small proportion of participants expressed dissatisfaction or very dissatisfaction Conclusion: In summary, the current study demonstrated high satisfaction with the LC treatment and highly reported QoL, which were mostly attributable to a number of factors such as the staff's cooperation, the lack of severe problems, and the sufficiency of the pre-surgery information supplied.


Introduction
Cholecystitis is typified by inflammation of the gallbladder, a little organ that sits under the liver [1,2].The most common cause is gallstones, which obstruct bile flow and cause inflammation and swelling of the gallbladder walls [1,3].Severe stomach discomfort, tenderness in the upper right abdomen, nausea, vomiting, and fever are some of the symptoms brought on by this inflammation [4,5].Diagnosing cholecystitis through physical examination, imaging studies, and blood work requires immediate medical intervention.Often, treatment entails removing the gallbladder by open or laparoscopic surgery [6,7].
A less invasive surgical procedure called laparoscopic cholecystectomy (LC) is used to remove the gallbladder [8,9].For disorders of the gallbladder, including gallstones and several gallbladder illnesses, it has emerged as the gold standard of care.Compared to open surgery, which is recognized for its advantages in shortened hospital stays, quicker recovery periods, and less discomfort following surgery, this approach has advantages [10,11].Even though LC is safe and effective, it is still critical to assess patient satisfaction and quality of life (QoL) after the treatment.
A key sign of any surgical intervention's success is patient satisfaction.Gaining an understanding of how patients view their post-LC experience can help drive future changes in patient care and offer important insights into the procedure's efficacy [12].Patient satisfaction may be impacted by a number of factors, such as pain control, surgical site healing, cosmetic results, and the overall perceived benefits of the procedure.
There is a need for a study evaluating satisfaction and QoL after undergoing LC in patients in Al-Qunfudhah Governorate, as there is limited research in this field.The objective of this study is to measure the level of patient satisfaction and QoL after undergoing LC in the Al-Qunfudhah Governorate by gathering the number of patients who had undergone LC.

Materials And Methods
A cross-sectional study was conducted targeting all patients who underwent LC in Al-Qunfudhah Governorate during the period from January to March 2024.Based on records, the sample size included 200 eligible patients from the Al-Qunfudhah Governorate of Saudi Arabia who had undergone the procedure during the study period.
Data were collected using a self-administered online questionnaire, which will be followed by approval to ensure data confidentiality.The online survey was initiated by the study researchers after an intensive literature review and experts' consultation.The validated questionnaire was uploaded online using Google Forms and distributed electronically via social media apps.The survey will consist of multiple-choice questions.The questionnaire of this study included four sections.The first section covered the participants' demographic characteristics.The respondents were asked general questions about their LC in the second section.Thirdly, the questions were about satisfaction level, and finally, the last section assessed the improvement of the QoL post-procedure.Ethical approval was obtained from the Biomedical Research Ethics Committee of Umm Al-Qura University, Al-Qunfudhah, Saudi Arabia (approval number: HAPO-02-K-012-2024-01-1969).

Statistical analysis
The statistical analysis was conducted using RStudio software, version 4.3.1 (Posit PBC, Boston, MA).Descriptive statistics were used to summarize the variables, whereas categorical variables were presented as frequencies and percentages.To assess the factors associated with participants' satisfaction with LC and the perceptions regarding the QoL after the procedure, chi-squared tests or Fisher's exact tests were performed, as appropriate.Furthermore, binary logistic regression analysis was conducted to identify predictors of participants' satisfaction with their QoL.The significantly associated variables in the inferential analysis testing were considered independent variables.Odds ratios (ORs) along with 95% confidence intervals (CIs) were calculated to estimate the strength and direction of associations.A p-value of less than 0.05 was considered statistically significant.

Demographic characteristics
The current study included records of 200 participants who had undergone LC procedures.The age distribution shows that the highest proportion falls within the 26 to 35 age group, comprising 57 individuals (28.5%).In terms of gender, males represent the majority, with 109 participants (54.5%).Saudi nationals make up the largest portion of the sample, accounting for 173 individuals (86.5%).Educationally, individuals with a bachelor's degree constitute the largest group, totaling 65 participants (32.5%).When considering employment status, the employed category is predominant, with 91 participants (45.5%,Table 1).In general, the majority of patients, comprising 122 individuals (61.0%), reported being satisfied with their procedures.Conversely, 18 patients (9.0%) expressed dissatisfaction, while 60 individuals (30.0%) provided neutral responses (Figure 1).

Participants' responses regarding their general information regarding LC
Among the participants, the majority reported experiencing no complications or adverse effects following LC (143 patients, 71.5%).Additionally, most respondents rated their improvement in QoL since the procedure as either moderate (83 patients, 41.5%) or significant (63 patients, 31.5%).In terms of postoperative pain compared to expectations, the highest proportion indicated experiencing pain as expected (63 patients, 31.5%).Regarding satisfaction with postoperative follow-up care provided by healthcare professionals, a considerable number expressed either satisfaction (86 patients, 43.0%) or very satisfaction (60 patients, 30.0%).Furthermore, the majority reported no recurrence of gallstone-related symptoms after the procedure (145 patients, 72.5%).The majority of participants (132 patients, 66.0%) reported not having any pre-existing conditions that affected their recovery after LC.Concerning the level of information provided about the potential risks and benefits of LC before the procedure, the most common response was being moderately informed (68 patients, 34.0%,Table 3).

Characteristic N=200
Experienced any complications or adverse effects following the laparoscopic cholecystectomy procedure

Participants' responses regarding LC healthcare team provider
Among the sample under study, the majority rated the communication with the surgical team before the procedure as either good (84 patients, 42.0%) or excellent (65 patients, 32.5%).Furthermore, most respondents reported being given adequate information regarding the preoperative preparations for LC (131 patients, 65.5%).Concerning the responsiveness of healthcare professionals to concerns and questions before the procedure, a notable proportion indicated either responsiveness (93 patients, 46.5%) or very responsiveness (53 patients, 26.5%).Regarding the clarity of instructions provided for postoperative care, responses varied with a significant portion finding instructions either clear (74 patients, 37.0%) or very clear (52 patients, 26.0%).The majority reported feeling supported by the healthcare team during the recovery period after LC (129 patients, 64.5%).Additionally, most participants expressed satisfaction with the information provided about potential complications and their management after the procedure (82 patients, 41.0%).When rating the overall professionalism and competence of the healthcare team involved in their LC, a substantial majority rated it as either good (78 patients, 39.0%) or excellent (84 patients, 42.0%).Lastly, most respondents reported that the healthcare team addressed their pain management needs effectively after LC (147 patients, 73.5%, Table 4).

Characteristic N=200
How would you rate the communication between you and the surgical team before the procedure?

TABLE 4: Participants' satisfaction regarding laparoscopic cholecystectomy surgical team
The values are given as n (%)

Participants' responses regarding their self-reported QoL after LC
A considerable proportion of patients rated their overall physical well-being after LC as either good (84 patients, 42.0%) or excellent (67 patients, 33.5%).Additionally, a significant proportion reported experiencing improvements in digestion and appetite after the procedure (128 patients, 64.0%).Regarding satisfaction with the ability to engage in physical activities, most respondents expressed either satisfaction (82 patients, 41.0%) or very satisfaction (55 patients, 27.5%).In terms of mental and emotional well-being, a substantial majority rated it as either good (80 patients, 40.0%) or excellent (87 patients, 43.5%).Furthermore, the majority reported no changes in their sleep patterns or quality of sleep since undergoing LC (107 patients, 53.5%).When assessing the impact on the ability to perform daily activities and tasks, a significant proportion reported moderate improvement (89 patients, 44.5%).Lastly, most respondents rated their social interactions and relationships after LC as either good (72 patients, 36.0%) or excellent (93 patients, 46.5%, Table 5).

Characteristic N=200
How would you rate your overall physical well-being after laparoscopic cholecystectomy?

TABLE 5: Participants' responses regarding their self-reported quality of life after laparoscopic cholecystectomy
The values are given as n (%) Importantly, the majority of participants under investigation expressed satisfaction with their overall QoL after undergoing LC, with 84 patients (42.0%) reporting satisfaction and 67 patients (33.5%) reporting being very satisfied.Additionally, only a small proportion of participants expressed dissatisfaction or very dissatisfaction, with 12 patients (6.0%) reporting dissatisfaction and seven patients (3.5%) reporting being very dissatisfied.Furthermore, a moderate number of respondents indicated a neutral stance, with 30 patients (15.0%) expressing neutrality towards their QoL post-surgery (Figure 2).

FIGURE 2: Overall satisfaction with the quality of life
Table 6 presents factors associated with participants' satisfaction with the QoL after LC.Notably, there was a significant difference in the perceived QoL in terms of education levels, with higher proportions of improved QoL among patients with a high school degree or less (47 patients, 90.7%) and Master's degree (21 patients, 80.8%) compared to those with the following degrees: diploma (37 patients, 74.0%), Bachelor's (41 patients, 63.1%) and PhD (three patients, 60.0%, p = 0.005).Moreover, a substantial difference in satisfaction was observed concerning participants' satisfaction with the LC procedure itself, with a significantly higher proportion of satisfied individuals reporting satisfaction with their QoL (104 patients, 85.2% vs 47 patients, 60.3% among those with no or neutral satisfaction, p < 0.001).Other variables, including age, gender, nationality, and employment status, did not show significant associations with satisfaction levels (p > 0.05, Table 6).In the regression model investigating the predictors of favorable perceptions of the QoL postoperatively, results showed that participants with a diploma level of education had lower odds of being satisfied with their QoL after the surgery compared to those with a high school education or less (OR=0.28,95% CI: 0.08, 0.84, p = 0.029).Similarly, individuals with a bachelor's degree had significantly lower odds of satisfaction (OR=0.15,95% CI: 0.05, 0.43, p < 0.001).Regarding satisfaction with the LC procedure itself, those who reported being satisfied had substantially higher odds of higher perceptions regarding their QoL (OR=4.

Discussion
The current study aimed to assess patient satisfaction and QoL after undergoing LC in Al-Qunfudhah Governorate, Saudi Arabia.Since the early 1990s, LC, a less invasive procedure for removing a diseased gallbladder, has become more popular than the open approach because of developments in medical technology [13].This treatment is currently the standard approach for a range of illnesses, ranging from symptomatic cholelithiasis and chronic cholecystitis to more severe problems such as gallstone pancreatitis [14].LC is extensively utilized in high-income nations due to its numerous benefits [15], including reduced hospital stays, quicker recovery periods, and decreased expenses [16].The safety of this product is remarkable, with an impressively low mortality rate ranging from 0.22% to 0.4% [17].
The current study showed that most of the study patients undergone LC were at their middle ages, males, with high education.Regarding post-LC satisfaction rate, the study results revealed that about two-thirds of them (61%) were satisfied with LC mainly Saudi patients but no gender or age differences regarding satisfaction were reported.This high satisfaction is mostly associated with that the vast majority of the cases had no complications after LC with an expected pain threshold.A much higher satisfaction was reported in Rwanda where overall satisfaction exceeded 95% and the vast majority of patients consider laparoscopic surgery as the best surgical approach [18].Another study by Saber and Hokkam [19] revealed that early LC resulted in a significant reduction in LOS an acceptable rate of operative complications and conversion rates and overall patient satisfaction between 75% and 93%.In Saudi Arabia, Aleid et al. [20] found that patients showed satisfaction with LC; however, complications were reported in a significant number of cases.However, a minority of participants were dissatisfied with LC.The authors also found no significant gender differences in post-surgery satisfaction which is consistence with the current study findings.Another study by Terro et al. [21] found that most of the patients were satisfied with postoperative pain management and their cosmetic appearance.Also, numerous studies have demonstrated that, despite an overall serious complication rate of 5%, which is still higher than that of an open cholecystectomy, LC has become more widely accepted with a higher satisfaction rate which may exceed 90% [22][23][24][25].Other studies revealed high satisfaction due to better cosmetic outcomes in LC compared to surgical procedures [26,27].
As for the post-LC QoL, the current study showed that about three-fourths (75.5%) of the study patients were satisfied with the QoL and this explains the reported high satisfaction with the procedure.Low education with satisfaction about the procedure itself was significantly associated with perceived high QoL.This can be due to the fact that low-educated persons have a lower threshold for their expectations regarding any undergone procedure compared to highly educated persons who mostly have high expectations [28,29].Also, improved appetite, physical activity, and sleep patterns were among the factors that improved their QoL.Similarly, in Saudi Arabia, Aleid et al. [20] documented that the majority of respondents said their QoL had moderately improved after LC.Demographic characteristics such as gender, age, and employment position had significant effects on satisfaction and QoL.In concordance with the current study findings, Mattila et al. [16] found that after LC, all patient groups reported notable reductions in physical discomfort and increased energy.Orthopedic and inguinal hernia patients experienced a considerable improvement in their physical performance.Postoperative physical health scores in the orthopedic groups did, however, remain comparatively lower than the reference values for the general population.Similar findings were also reported by Lamberts et al. [30].Another study conducted by Bohara et al. [31] revealed a significant increase in QoL after LC in symptomatic patients.Likewise, Gach et al. [32] found that 84.9% of the symptomatic group experienced an improvement in their health condition and 5.7% remained unchanged.These reported high QoL afire LC were also approved by many other researchers in the literature indicating the procedure's high effectiveness and acceptance [33][34][35].
With regard to participants' perception regarding the procedure and healthcare staff, high satisfaction with the staff's role in providing information before surgery, response to explanations, good communication, and high support.This also explains their high satisfaction and post-LC-related QoL.The study may have a limited sample size due to various factors such as resource constraints, time limitations, or a small population in Al-Qunfudhah Governorate.A small sample size may limit the generalizability of the findings to a larger population.Also, the study may have a limited follow-up duration, which could impact the ability to capture long-term outcomes and changes in patient satisfaction and QoL.Longer follow-up periods provide a more comprehensive understanding of the postoperative effects of LC.

TABLE 2 : Factors associated with participants' satisfaction with laparoscopic cholecystectomy The
values are given as n (%) Fisher's exact test; Pearson's Chi-squared test

TABLE 3 : Participants' responses regarding their general information regarding laparoscopic 2024
Taha et al.Cureus 16(6): e62276.DOI 10.7759/cureus.62276cholecystectomy The values are given as n (%) How would you rate your mental and emotional well-being after laparoscopic cholecystectomy?