Conventional open versus laparoscopic surgery for peritoneal dialysis (PD) peritonitis

Post-operative pain levels and analgesic requirements. The following outcome data are collected:
1. Duration of the surgical operation (time from first incision to last skin suture)
2. Post-operative pain levels and analgesic requirements:
2.1. Pain assessed daily using a linear analogue scale (100 mm line with 'no pain at all' written at the left hand (zero) end and 'worst pain imaginable' written at the right hand (100) end
2.2. Post-operative analgesic use recorded by the nursing staff and pain team using the standard PCAS (Patient Controlled Analgesia System) form. This includes the total dose of morphine used in mg and the duration of PCAS use in hours

Return to normal activities and post-operative respiratory function.

1. Resumption of normal activities:
1.1. In-patient assessment includes grip strength, measured pre operatively then daily whilst an in-patient and in the clinic one and three months postoperatively. The timed Up and Go measured pre operatively, then at three and five days post operatively, at discharge, then at the one and three monthly clinic visits (patients are timed as they rise from a standard chair, walk 3 metres, turn, walk back and sit). The duration of post-operative in-patient stay is also recorded.
1.2. At the time of discharge, patients are assessed on their Activities of Daily Living (ADL) 6 by scoring the following activities on a 3 point scale. (1: no help needed, 2: needing help, 3: unable to do). An assessment is also made pre operatively:
1.2.1. Grooming
1.2.2. Feeding
1.2.3. Toileting
1.2.4. Bathing
1.2.5. Dressing
1.2.6. Transferring from bed to chair
1.2.7. Walking across a room
These are then assessed again at the one and three monthly clinic appointments.

2. Respiratory function:
2.1. Assessed preoperatively and on the first, third and fifth postoperative days by spirometry (Forced expiratory volume in one second [FEV1] and forced vital capacity [FVC]).

3. The metabolic response to surgery:
3.1. Investigated by daily measurements of C-reactive protein and plasma cytokine levels (tumour necrosis factor-α [TNF-α]; interleukin-1 [IL-1] and IL-6).

4. Complication rates:
4.1. This includes mortality, wound complications (infection, hernia), chest complications (infection, pneumonia, atelectesis), thrombo-embolic disease (deep vein thrombosis, pulmonary embolism) and any other adverse event. Re-operation rates for persisting infection are also recorded.

5. Post operative recovery:
5.1. The Multidimensional Fatigue Inventory (MFI-20) is given to the patient at the one and three month clinic visit 7. The questionnaire assesses general fatigue, physical, reduced activity, reduced motivation and mental fatigue.
5.2. More complex care abilities are assessed pre operatively then at the one and three monthly clinic visits using the Instrumental Activities of Daily Living scale (IADL) 6, again on a 3-point scale:
5.2.1. Using the telephone
5.2.2. Accessing transportation away from home
5.2.3. Shopping
5.2.4. Preparing meals
5.2.5. Housework
5.2.6. Laundry
5.2.7. Managing medication
5.2.8. Managing finances