Recovery After Same-Day Surgery in Patients Receiving General Anesthesia: A Cohort Study Using the Quality of Recovery-40 Questionnaire

Assessing the Quality of Postoperative Recovery: A Guide for Making Adjustments in Anesthesia Delivery

PURPOSE

The purpose of this project was to develop a plan and then implement a process for improving anesthesia delivery at a surgery center in the Southeast United States over a 2-month period.

DESIGN

The design of the project was based on utilization of the instrument QoR-15 (Quality of recovery - 15 item questionnaire). This tool is a valid and reliable instrument for the measurement of postoperative outcomes. The QoR-15 includes 15 questions that can each be scored on a 10-point scale.

METHODS

Methods included a literature search, collecting pre-assessment data, making phone calls to patients utilizing QoR-15 tool, analyzing data, presenting findings to stakeholders, creating a plan of future anesthesia care adjustments.

FINDINGS

The results revealed the following outcome data: a total of 183 postoperative phone calls were successfully performed. The calls were completed on the first postoperative day during the months of July and August 2021. There were 459 total cases during this 2-month period with 113 successful patient contacts (24.6 % successful contact rate). Mean scores of the QoR-15 data for the total population were above 9 for all 15 items. The data was then analyzed according to surgical specialty. The category of moderate pain scores in patients from the General and Ophthalmology surgical specialties were 7.9 and 7.8 respectively. General surgery patients also had one of the highest scores in severe pain with a mean of 8.7.

CONCLUSIONS

In conclusion, the leadership team at the ASC received a formal presentation of the results and recommendations for future adjustments that could be potentially implemented in anesthesia care. The benefits of regional anesthesia were suggested to help achieve better patient pain outcomes in both the General and Ophthalmologic surgical populations.

Factors Associated With Prolonged-Stay Patients Within the Post-anesthesia Care Unit: A Cohort Retrospective Study

BACKGROUND

The post-anesthesia care unit (PACU) plays a crucial role in providing specialized care to postoperative patients. However, a subset of these patients experiences complications that result in a prolonged stay of 90 minutes or more in the PACU. This not only impacts the patient's quality of life but also disrupts hospital workflow, as it might cause postoperative pain, nausea, or vomiting. It is essential to identify the factors contributing to this prolonged length of stay (LOS) and explore strategies for its prevention and management.  Methods: We conducted a retrospective cohort study of postoperative patients between 2020 and 2021. We included patients who had a prolonged stay, excluding cardiac patients, patients who had a planned prolonged stay, and patients waiting for an intensive care unit bed. We used a non-probability consecutive sampling technique. Data were obtained from the BestCare System, the hospital's information system, using a data collection sheet.

RESULTS

A total of 15,170 patients underwent surgical procedures during the study period, out of which only 181 (1.19%) experienced a prolonged PACU stay. Pain and altered mental status were strongly associated with a prolonged PACU stay (P = 0.035 and P = 0.0009, respectively). However, there was no significant association between overall comorbidities and prolonged LOS in the PACU, except for patients with asthma (P = 0.003). Different types and durations of surgeries did not significantly contribute to a prolonged PACU stay.

CONCLUSIONS

Our study found that among the various variables examined, asthma, pain, and altered mental status were significantly associated with a prolonged LOS in the PACU. These findings suggest that targeted interventions addressing these factors may help reduce the incidence of prolonged PACU stays and optimize patient outcomes.

Postoperative Recovery Quality after General Anesthesia in Patients Undergoing Emergency Surgery

BACKGROUND: The quality of post-operative patient recovery is part of the indicators of the quality of anesthesia services. However, side effects were still found in post-operative patients, which resulted in the speed and quality of recovery (QoR) and an increase in the length of stay for patients in the hospital. AIM: This study aims to describe the quality of a patient’s recovery after general anesthesia for patients undergoing surgery in the emergency room. MATERIALS AND METHODS: This research is a descriptive study with a cross-sectional design conducted from February to July 2020. Patients numbered 52 people who are patients aged 18–59 years who are willing to fill out a questionnaire QoR-40 on the day after surgery. All data were analyzed using the statistical program SPSS. The median of the QoR-40 score will be used as a cutoff point between good and poor recovery quality. RESULTS: Fifty-two patients responded to the study with a median age of 44 years. The median QoR-40 score was 188, with most of the good category’s recovery quality (55.8%). The middle-aged group showed better QoR (68.2 vs. 31.8%), as well as the female compared to male (65 vs. 35%). Patients who underwent neurosurgery showed poor recovery 61.9 vs. 38.1%). CONCLUSION: More than half of the patients who underwent emergency surgery under general anesthesia in the emergency room of Sanglah Hospital have good recovery quality.

The Effects of Preoperative and Postoperative Anxiety on the Quality of Recovery in Patients Undergoing Abdominal Surgery

PURPOSE

The aim of this study was to investigate the effect of preoperative and postoperative anxiety on the state of recovery in patients undergoing abdominal surgery.

DESIGN

This research is a descriptive and cross-sectional study.

METHODS

The study included a total of 82 patients undergoing elective abdominal surgery. Demographic data were collected. State-Trait Anxiety Inventory was the measure for anxiety. The quality of recovery (QoR) was assessed using Quality of Recovery Scale (QoR-40). Both have known validity and reliability and valid translations into Turkish. After obtaining consent from patients, 82 patients completed their demographic profile and State-Trait Anxiety Inventory before surgery, and after 24 hours of surgery completed the state anxiety and QoR.

FINDINGS

Patients who received general anesthesia had higher anxiety before and after surgery (P = .004 and P = .022). Patients who were not informed about the surgery had higher preoperative trait anxiety (P = .01). The QoR scores of the patients were negatively related to preoperative and postoperative state anxiety (P = .01 and P = .000). Preoperative state anxiety was positively related to preoperative trait and postoperative state anxiety (P = .000 and P = .000).

CONCLUSIONS

The results provided more evidence that patients need education before surgery as to what to expect both in the surgical suite and immediately after surgery to alleviate anxiety. This should also improve QoR.

Swedish Web Version of the Quality of Recovery Scale Adapted for Patients Undergoing Local Anesthesia and Peripheral Nerve Blockade (SwQoR-LA): Prospective Psychometric Evaluation Study

BACKGROUND

The frequency and timing of assessing patient symptoms and discomfort during postoperative recovery are goals. Therefore, real-time recovery evaluation has been suggested to identify specific deficits in patient recovery.

OBJECTIVE

This study aimed to psychometrically evaluate the Swedish Web Version of the Quality of Recovery (SwQoR) Scale adapted for patients undergoing local and peripheral nerve block (SwQoR-LA).

METHODS

This was a secondary analysis of a psychometric evaluation of 107 patients aged ≥18 years undergoing day surgery under local or peripheral nerve block anesthesia at 4 different day surgery departments in Sweden. The SwQoR-LA, available through a mobile app called Recovery Assessment by Phone Points (RAPP), was completed daily on postoperative days 1-7.

RESULTS

Some evidence of construct validity was supported, and discriminant validity was found in 7 of 8 items related to general anesthesia. The internal consistency was acceptable (.87-.89), and the split-half reliability was 0.80-0.86. Cohen d effect size was 0.98, and the percentage of change from baseline was 43.4%. No floor nor ceiling effects were found.

CONCLUSIONS

The SwQoR-LA is valid, reliable, responsive, and clinically feasible for digital real-time recovery assessment of patient recovery to identify specific deficits in patient recovery and detect those patients who might benefit from a timely intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02492191; https://clinicaltrials.gov/ct2/show/NCT02492191.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2015-009901.

A cross-sectional study to assess the difference in perception of day surgery information between patients and medical staff in China

PURPOSE

The development of day surgery in China is still in its infancy. The aim of this study is to examine the difference in perception between patients and medical staff about day surgery and to find out what kind of information should be delivered to patients perioperatively.

METHODS

The study was designed as a cross-sectional study using survey questionnaires. Patients undergoing day surgery and medical staff working in the day surgery center received a preoperative teaching questionnaire (PTQ). The PTQ consisted of preoperative, operative, postoperative and anesthesia information. Participants were asked to rate accurately what day surgery information they perceived as important on a five-point Likert-type scale that ranged from very important to not important. The main outcome was the value patients and staff place on perioperative information.

RESULTS

For patients, details of anesthesia (82.6%) was the most important day surgery information, while for medical staff, preoperative (58.1%), postoperative (60.7%) and anesthesia (60.0%) information were of the same importance. Patients ranked surgery effect (83.3%) and pain management (82.5%) as two of the top five most important details about day surgery, but these were not listed in the top 5 rankings of staff. Student's t-test results of mean rankings also showed that patients placed more importance on surgery effect (4.8±0.6, 4.6±0.6, P=0.036) and pain management (4.8±0.5, 4.5±0.5, P=0.031) than the medical staff did.

CONCLUSION

In China, day surgery is an emerging practice with both patients and medical practitioners still lacking experience, so high-quality perioperative teaching is necessary and important. Our study examining patients and staffs' views on day surgery information should be considered when developing perioperative teaching programs. To increase patient satisfaction of the day surgery experience, delivery of patient-specific information tailored to individual circumstances is necessary.

Postoperative Recovery After General and Regional Anesthesia in Patients Undergoing Day Surgery: A Mixed Methods Study

PURPOSE

To investigate differences and describe experiences of postoperative recovery after day surgery between patients undergoing general anesthesia (GA) versus regional anesthesia (RA).

DESIGN

A mixed methods design.

METHODS

Day surgery patients (N = 401) were included. Postoperative recovery was assessed daily for 14 days using the Swedish Web Version of the Quality of Recovery questionnaire included in a mobile application. In addition, qualitative interviews were completed with 20 day surgery patients. Quantitative and qualitative data were first analyzed separately and then merged.

FINDINGS

There were significant differences in Swedish Web Version of the Quality of Recovery between GA and RA on days 1 to 13 (P < .05). These findings could not be confirmed in the qualitative findings, except for psychological issues as well as tiredness and fatigue. Unexpected issues contributed to a greater extent to the theme not feeling well. Pain in the surgical wound was overall the biggest problem.

CONCLUSIONS

There seems to be a poorer recovery after GA compared with RA. Tiredness or fatigue is present also after minor surgery in RA. Unexpected issues affect recovery negatively, and therefore should be addressed by health care.

Holding It Together-Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study

Background

There is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery.

Objective

The aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery.

Methods

This is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis.

Results

A total of two themes and six subthemes emerged from the data: (1) the theme Give it all you’ve got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin.

Conclusions

It is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery.

Sex Similarities in Postoperative Recovery and Health Care Contacts Within 14 Days With mHealth Follow-Up: Secondary Analysis of a Randomized Controlled Trial

Background

Previous studies have shown that women tend to have a poorer postanesthesia recovery than men. Our research group has developed a mobile phone app called Recovery Assessment by Phone Points (RAPP) that includes the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire to monitor and assess postoperative recovery.

Objective

The aim of this study was to investigate sex differences in postoperative recovery and the number of health care contacts within 14 postoperative days in a cohort of day-surgery patients using RAPP.

Methods

This study was a secondary analysis from a single-blind randomized controlled trial. Therefore, we did not calculate an a priori sample size regarding sex differences. We conducted the study at 4 day-surgery settings in Sweden from October 2015 to July 2016. Included were 494 patients (220 male and 274 female participants) undergoing day surgery. The patients self-assessed their postoperative recovery for 14 postoperative days using the RAPP.

Results

There were no significant sex differences in postoperative recovery or the number of health care contacts. Subgroup analysis showed that women younger than 45 years reported significantly higher global scores in the SwQoR questionnaire (hence a poorer recovery) on postoperative days 1 to 10 than did women who were 45 years of age or older (P=.001 to P=.008). Men younger than 45 years reported significantly higher global scores on postoperative days 2 to 6 than did men 45 years of age or older (P=.001 to P=.006). Sex differences in postoperative recovery were not significant between the age groups.

Conclusions

This study found sex similarities in postoperative recovery and the number of health care contacts. However, subgroup analysis showed that age might be an independent factor for poorer recovery in both women and men. This knowledge can be used when informing patients what to expect after discharge.

Trial Registration

ClinicalTrials.gov NCT02492191; https://clinicaltrials.gov/ct2/show/NCT02492191 (Archived by WebCite at http://www.webcitation.org/6y2UtMbvz)

Postoperative Symptom Distress of Laparoscopic Cholecystectomy Ambulatory Surgery Patients

PURPOSE

The purposes of this study were to (1) identify symptoms that cause postoperative distress in ambulatory surgery patients; (2) identify symptom management techniques that effectively reduce distress of laparoscopic cholecystectomy (LC) postoperative symptoms at home after ambulatory surgery; and (3) identify facilitators and barriers to self-management of postoperative symptoms.

DESIGN

A qualitative descriptive study.

METHODS

Two focus groups of ambulatory surgery patients who had experienced a laparoscopic cholecystectomy procedure and their caregivers were queried to elicit understanding of postoperative symptoms and symptom management techniques.

FINDINGS

Themes identified included distressing symptoms and consequences of surgery, symptom management, and self-management facilitators and barriers. Pain was a major symptom after surgery and impacted mobility and sleep. Participants in our study wanted realistic information about symptoms and more specific information on symptom management. Caregivers were important to the success of symptom management but experienced their own stress.

CONCLUSIONS

Perianesthesia nurses should focus not only on the immediate recovery, but also prepare patients and their caregivers for the more prolonged issues of recovery at home.

The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study

Background

The 40-item Quality of Recovery (QoR-40) questionnaire is well validated for measuring self-assessed postoperative recovery. The Swedish version of the 40-item Quality of Recovery (QoR-40) has been developed into a Web-based questionnaire, the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire, adapted for use in a mobile app, Recovery Assessment by Phone Points, or RAPP.

Objective

The aim of this study was to test the validity, reliability, responsiveness, and clinical acceptability and feasibility of SwQoR.

Methods

We conducted a prospective psychometric evaluation study including 494 patients aged ≥18 years undergoing day surgery at 4 different day-surgery departments in Sweden. SwQoR was completed daily on postoperative days 1 to 14.

Results

All a priori hypotheses were confirmed, supporting convergent validity. There was excellent internal consistency (Cronbach alpha range .91-.93), split-half reliability (coefficient range .87-.93), and stability (ri=.99, 95% CI .96-.99; P<.001). Cohen d effect size was 1.00, with a standardized response mean of 1.2 and a percentage change from baseline of 59.1%. An exploratory factor analysis found 5 components explaining 57.8% of the total variance. We noted a floor effect only on postoperative day 14; we found no ceiling effect.

Conclusions

SwQoR is valid, has excellent reliability and high responsiveness, and is clinically feasible for the systematic follow-up of patients’ postoperative recovery.

Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study

Objective:

to assess the factors associated with the risk of fall in patients undergoing surgical procedures.

Method:

quantitative and cross-sectional study carried out with 257 adult patients in a hospital in the state of Minas Gerais, Brazil. Data were collected using the sociodemographic and clinical questionnaire, the Morse Fall Scale, and the Quality of Recovery Score. Data were submitted to descriptive statistical analysis and multinomial logistic regression. The level of significance was set at 0.05.

Results:

35.4% of patients had high risk of falls, 38.9% had moderate risk and 25.7% had low risk. The mean value in the surgical recovery scale was 175.37 points and no patient presented poor surgical recovery. Regarding the results of the bivariate analysis, it was found that age (p<0.001), SAH (p<0.001) and diabetes (p=0.017) were positively associated with high risk of fall, whereas cancer (p=0.004) was positively associated with moderate risk of fall. Surgical recovery (p=0,008) was inversely associated with high risk of fall.

Conclusion:

the results of this study allowed the identification of five factors associated with the risk of fall in adults in the postoperative hospital stay. These findings may support the planning of nursing actions aimed at preventing the risk of fall in the postoperative period.