Trends in patient reported outcomes of conservative and surgical treatment of primary chronic venous disease contradict current practices.

OBJECTIVE: To analyze patient-reported quality of life (QOL) and symptoms in a prospective cohort of CVD patients who was managed within the framework of existing policies. STUDY DESIGN: Prospective cohort study of 150 patients with C2-C4 clinical class of primary chronic venous disease (CVD). Management consisted of initial conservative measures, following which, the patients were given a choice of continuing conservative therapy, or surgical treatment. Patients completed Specific Quality of Life and Outcome Response--Venous (SQOR-V) tool before initial visit, after completion of conservative treatment, and at 1 and 12 month follow up visits after surgical treatment. Management consisted of initial conservative measures. QOL score and symptom score (SS) part of this instrument was analyzed separately. RESULTS: Conservative treatment resulted in improvement of symptom score in 85(57%) patients, and the QOL in 111(74%) patients. Despite this improvement, the majority of patients (121) chose surgical option. At the 1-month follow up after surgical treatment 97 (80%) patients reported significant improvement of their symptoms and 114 (94%) in the QOL compare to their status after conservative therapy. The QOL improvement was due mainly to improvement in symptom score. Patients who improved after conservative therapy were more than 15 times more likely to have symptoms relief at 1 month (RR = 15.6, 95% CI 4.3-56.5), and 21 times higher at 1 year after surgery (RR = 21.3, 95% CI 4.7-96.9) compared with those who did not change the SS. CONCLUSIONS: Surgical treatment resulted in a better relief of symptoms compare to conservative therapy. The relief of symptoms after conservative therapy predicts better outcomes of surgical treatment. These findings suggest that success of conservative therapy should be considered as an indication, and the failure of conservative therapy should not be an indication to surgical treatment.