C S Cinà1, S G W Robertson, E J M Young, B Cartier, C M Clase. 1. Division of Vascular Surgery, Department of Biostatistics and Epidemiology, McMaster University, Victoria Medical Centre Hamilton, ON, Canada.
Abstract
AIM: The objective of this study was to assess the impact of bilateral endoscopic thoracic sympathectomy (ETS) on the quality of life of patients with hyperhidrosis of the upper limbs. METHODS: This is a prospective, multicentre cohort study. Patients were studied before surgery and early (within 2 months) and late (4 months or more) after surgery. The primary outcome was the total score of the illness intrusiveness rating scale (IIRS), which on a sevenpoint Likert scale assesses the impact of their disease on each of 13 domains of quality of life. At each visit participants completed the IIRS, 10 additional questions to assess severity of disease, a global severity item, questions about employment, companionship and smoking, and a single item question reflecting the results of surgery. RESULTS: From 1994 to 2003, 22 patients underwent surgery. Early postoperative data were available in 12, and late postoperative data in 19 patients. Preoperative IIRS score was high 57 +/- 14. After surgery a statistically significant improvement was noted for the IIRS score, the severity questions, and the global severity score at both early and late postoperative time points. Preoperatively, 47% of patients were in a stable relationship, 30% were currently smoking, and 73% were employed; postoperatively, the responses were 58%, 16%, and 90%, respectively (P = NS). One patient (5%) developed a postoperative pneumothorax and one (5%) compensatory hyperhidrosis. There were no other local complications and none developed Horner's syndrome. CONCLUSIONS: Using a reliable and valid quality of life instrument we have shown that surgery is effective for the treatment of hyperhidrosis. Given the possibility of complications, we believe that surgery should be reserved for patients with the most severe form of this condition. The severity can be defined by the use of the IIRS and the 10 severity questions, which we have designed.
AIM: The objective of this study was to assess the impact of bilateral endoscopic thoracic sympathectomy (ETS) on the quality of life of patients with hyperhidrosis of the upper limbs. METHODS: This is a prospective, multicentre cohort study. Patients were studied before surgery and early (within 2 months) and late (4 months or more) after surgery. The primary outcome was the total score of the illness intrusiveness rating scale (IIRS), which on a sevenpoint Likert scale assesses the impact of their disease on each of 13 domains of quality of life. At each visit participants completed the IIRS, 10 additional questions to assess severity of disease, a global severity item, questions about employment, companionship and smoking, and a single item question reflecting the results of surgery. RESULTS: From 1994 to 2003, 22 patients underwent surgery. Early postoperative data were available in 12, and late postoperative data in 19 patients. Preoperative IIRS score was high 57 +/- 14. After surgery a statistically significant improvement was noted for the IIRS score, the severity questions, and the global severity score at both early and late postoperative time points. Preoperatively, 47% of patients were in a stable relationship, 30% were currently smoking, and 73% were employed; postoperatively, the responses were 58%, 16%, and 90%, respectively (P = NS). One patient (5%) developed a postoperative pneumothorax and one (5%) compensatory hyperhidrosis. There were no other local complications and none developed Horner's syndrome. CONCLUSIONS: Using a reliable and valid quality of life instrument we have shown that surgery is effective for the treatment of hyperhidrosis. Given the possibility of complications, we believe that surgery should be reserved for patients with the most severe form of this condition. The severity can be defined by the use of the IIRS and the 10 severity questions, which we have designed.