Objective This study aimed to map the Insomnia Severity Index (ISI) to the EQ-5D-3L utility values from a UK perspective. Methods Source data were derived from the 2020 National Health and Wellness Survey (NHWS) for France, Germany, Italy, Spain, the UK and the US. Ordinary least squares regression, generalised linear model (GLM), censored least absolute deviation, and adjusted limited dependent variable mixture model (ALDVMM) were employed to explore the relationship between ISI total summary score and EQ-5D utility while accounting for adjustment covariates derived from the NHWS. Fitting performance was assessed using standard metrics, including mean-squared error (MSE) and coefficient of determination (R 2 ). Results A total of 17,955 respondent observations were included, with a mean ISI score of 12.12 ± 5.32 and a mean EQ-5D-3L utility (UK tariff) of 0.71 ± 0.23. GLM gamma-log and ALDVMM were the two best performing models. The ALDVMM had better fitting performance (R 2 = 0.320, MSE 0.0347) than the GLM gamma-log (R 2 = 0.303, MSE 0.0353); in train-test split-sample validation, ALDVMM also slightly outperformed the GLM gamma-log model, with an MSE of 0.0351 versus 0.0355. Based on fitting performance, ALDVMM and GLM gamma-log were the preferred models. Conclusions In the absence of preference-based measures, this study provides an updated mapping algorithm for estimating EQ-5D-3L utilities from the ISI summary total score. This new mapping not only draws its strengths from the use of a large international dataset but also the incorporation of adjustment variables (including sociodemographic and general health characteristics) to reduce the effects of confounders.

No abstract

Background: Laparoscopic surgery (LS) requires CO2 insufflation to establish the operative field. Patients with worsening pain post-operatively often undergo computed tomography (CT). CT is highly sensitive in detecting free air—the hallmark sign of a bowel injury. Yet, the clinical significance of free air is often confounded by residual CO2 and is not usually due to a visceral injury. The aim of this study was to attempt to quantify the residual pneumoperitoneum (RPP) after a robotic-assisted laparoscopic prostatectomy (RALP). Methods: We prospectively enrolled patients who underwent RALP between August 2018 and January 2020. CT scans were performed on postoperative days (POD) 3, 5, and 7. To investigate potential factors influencing the quantity of RPP, correlation plots were made against common variables. Results: In total, 31 patients with a mean age of 66 years (median 67, IQR 62–70.5) and mean BMI 26.59 (median 25.99, IQR: 24.06–29.24) underwent RALP during the study period. All patients had a relatively unremarkable post-operative course (30/31 with Clavien–Dindo class 0; 1/31 with class 2). After 3, 5, and 7 days, 3.2%, 6.4%, and 32.3% were completely without RPP, respectively. The mean RPP at 3 days was 37.6 mL (median 9.58 mL, max 247 mL, IQR 3.92–31.82 mL), whereas the mean RPP at 5 days was 19.85 mL (median 1.36 mL, max 220.77 mL, IQR 0.19–5.61 mL), and 7 days was 10.08 mL (median 0.09 mL, max 112.42 mL, IQR 0–1.5 mL). There was a significant correlation between RPP and obesity (p = 0.04665), in which higher BMIs resulted in lower initial insufflation volumes and lower RPP. Conclusions: This is the first study to systematically assess RPP after a standardized laparoscopic procedure using CT. Larger patients tend to have smaller residuals. Our data may help surgeons interpreting post-operative CTs in similar patient populations.

Objective Laparoscopic surgery improves the postoperative recovery process and relies on CO2 insufflation to establish the operative field. Most residual CO2 is expelled prior to port and incision closure. Computed tomography (CT) is often used to assess an acute abdomen and is highly sensitive in detecting free intra-abdominal air – the hallmark sign of a bowel injury. Yet, the clinical significance of free air in the early postoperative period is confounded by residual CO2 and is not usually due to a visceral injury. The aim of this prospective study was to systematically quantify the residual pneumoperitoneum (RPP) at varying timepoints after robotic-assisted laparoscopic surgery. Methods Patients undergoing robot-assisted laparoscopic intervention, both radical prostatectomies and left hemicolectomies, were prospectively enrolled in the study. At the conclusion of each operation, manual abdominal pressure was applied to aid in exsufflation of residual CO2. Very-low-dose CT scans were performed on postoperative days (POD) 3, 5, and 7, with subsequent volumetric quantification of RPP. To investigate potential factors influencing the quantity of RPP, correlation plots were made against BMI, age, operative time, total insufflation volume, intra-abdominal pressure, time to flatus and first bowel movement, pain score, and postoperative analgesic requirement. Results Thirty-one patients undergoing robotic assisted laparoscopic prostatectomy were untill now enrolled in the study, of which only one experienced a Clavien-Dindo 2 complication; all others were free of any complications during post-operative assessment period. On POD3, 5, and 7, 97%, 94%, and 68% of patients, respectively, demonstrated RPP. The RPP volumes were noted to be 9.6 mL (IQR = 3.9-31.8; maximum = 247 mL) on POD3, 1.0 mL (0.1-5.1; maximum = 221 mL) on POD5, and 0.08 mL (1-1.2; maximum = 112 mL) on POD7. A significant correlation was only appreciated between RPP volume and BMI; those with higher BMIs had lower initial volumes of RPP on POD3 and exhibited a more rapid decrease in RPP over one week. Conclusion One week after robot-assisted laparoscopic operations, a majority of patients will exhibit clinically insignificant RPP, even with volumes as high as 250 mL. Larger patients tend to have smaller residuals of CO2. Our data provide new basic knowledge regarding RPP and may help to interpret postoperative CT-scans.