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Nearly one-third of adults in developed countries suffer from varicose veins which can reduce their health-related quality of life (HRQL). Symptoms can include aching, pain and itching, and severe cases can lead to serious to permanent skin damage and ulceration of the leg. 

“Fortunately treatments or surgery for varicose veins (often referred to as superficial venous surgery or SVS) can return the majority of patients to normal HRQL,” said Rachel C. Sam, MA, MRCS, from the Department of Vascular Surgery, Birmingham University, United Kingdom.

“Despite data that shows the success of intervention, many health care purchasers believe that SVS is a cosmetic procedure and should not be reimbursed by publicly-funded health services or by private health insurance,” said Sam. “The spiralling costs of health care mean that tough funding decisions have to be made, and some form of prioritization or rationing seems inevitable. However, like clinical decisions, these financial decisions should be based on evidence.”

To find out if this vascular procedure is equally as important as other general surgeries, Sam and her research team compared HRQL improvements for 143 SVS patients to 60 patients who had elective laparoscopic cholecystectomy (ELC). The latter procedure consists of the removal of the gallbladder via keyhole surgery for biliary colic (gallstone pain). The results were published in the September issue of the Journal of Vascular Surgery.

Health-related quality of life data was gathered from patients from the Heart of England NHS Trust Hospital’s department of vascular surgery in Birmingham. All patients completed Short Form 12 questionnaires about their HRQL before surgery and at three, six and 12 months after their procedure. “The advantage of the questionnaire is that the relative value to patients of quite different interventions can be compared,” noted Sam.

Preoperatively, and at three and 12 months after surgery, ELC group patients had a significantly lower physical component summary (PCS), thus lower HRQL, than those in the SVS group (40.2 vs. 49.5, 48.9 vs. 53.1, 45.4 vs. 53.8 respectively). Even with significant improvement in PCS in the ELC group over the first three postoperative months (which was sustained at six and 12 months), the change in PCS and HRQL observed over the first year following surgery was not significantly different between the groups. The ELC patients had a significantly lower mental component summary (MCS) than the SVS group preoperatively (45.9 vs. 50.8), but there was no significant difference in MCS postoperatively. 

“Our study provides further strong evidence for the clinical benefit of SVS surgery and suggests that it should not be ‘rationed’ anymore than gallbladder surgery for gallstone-related colic,” added Sam. “To our knowledge, this is the first study to compare patient reported outcomes after SVS with those observed after other commonly performed general and vascular operations. This data will lend further support to the clinical benefit of SVS and will help health care purchasers make decisions regarding the prioritization of vascular and general surgical services.”