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Wilson HH, Augenstein VA, Colavita PD, Davis BR, Heniford BT, Kercher KW, Kasten KR. Disparate potential for readmission prevention exists among inpatient and outpatient procedures in a minimally invasive surgery practice. Surgery 2024; 175:847-855. [PMID: 37770342 DOI: 10.1016/j.surg.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Administrators have focused on decreasing postoperative readmissions for cost reduction without fully understanding their preventability. This study describes the development and implementation of a surgeon-led readmission review process that assessed preventability. METHODS A gastrointestinal surgical group at a tertiary referral hospital developed and implemented a template to analyze inpatient and outpatient readmissions. Monthly stakeholder assessments reviewed and categorized readmissions as potentially preventable or not preventable. Continuous variables were examined by the Student's t test and reported as means and standard deviations. Categorical variables were examined by the Pearson χ2 statistic and Fisher's exact test. RESULTS There were 61 readmission events after 849 inpatient operations (7.2%) and 16 after 856 outpatient operations (1.9%), the latter of which were all classified as potentially preventable. Colorectal procedures represented 65.6% of readmissions despite being only 37.2% of all cases. The majority (67.2%) of readmission events were not preventable. Compared to the not-preventable group, the potentially preventable group experienced more dehydration (30.0% vs 9.8%, P = .045) and ileostomy creation (78.6% vs 33.3%, P = .017). The potential for outpatient management to prevent readmission was significantly higher in the potentially preventable group (40.0% vs 0.0%, P < .001), as was premature discharge prevention (35.0% vs 0.0%, P < .001). CONCLUSION The use of the standardized template developed for analyzing readmission events after inpatient and outpatient procedures identified a disparate potential for readmission prevention. This finding suggests that a singular focus on readmission reduction is misguided, with further work needed to evaluate and implement appropriate quality-based strategies.
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Townshend R, Grondin C, Gupta A, Al-Khafaji J. Assessment of Patient Retention of Inpatient Care Information Post-Hospitalization. Jt Comm J Qual Patient Saf 2023; 49:70-78. [PMID: 36494268 DOI: 10.1016/j.jcjq.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patient understanding of medical care improves readmission rates and patient satisfaction, yet the literature suggests patients often have poor retention of care information post-hospitalization. Although multiple interventions have been implemented to facilitate this process, the cumulative durability of their benefit remains unclear. The authors conducted this study to more objectively understand how well patients retain care information after hospital discharge and to assess patient perspectives on facilitators of this process (for example, whiteboards and patient portals). METHODS Semistructured phone interviews of patients admitted to general medicine resident teaching services were performed within 24 to 48 hours post-hospitalization. Recall of four key domains of care (diagnoses addressed, inpatient treatment, postdischarge treatment plans, and medication changes) was elicited. Chart review was performed to verify patient responses. Responses were then categorized by independent reviewers as correct, partially correct, or incorrect. Patient perspectives on facilitators to help with information retention were also assessed. RESULTS Fifty-three patients participated. The vast majority (> 90%) were confident in their knowledge of their diagnoses and treatment, yet independent review revealed only 58.5%, 64.2%, 50.9%, and 43.4% of patients correctly recalled each respective key domain. Whiteboards were the most frequently used facilitator (96.2%), yet their content was rated least helpful for retaining care information. Patients suggested several areas for improvement, including prioritizing bedside pen and paper along with updating whiteboards with diagnostic and therapeutic information. CONCLUSION Patient recall of their inpatient care after discharge, despite modern facilitators, remains poor. Further efforts are needed to enhance or implement facilitators based on patient feedback.
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Jovelijic J, Shinners LR, Coutts RA. An evaluation of the use of an iPad for hospital orientation in a regional hospital. Collegian 2023. [DOI: 10.1016/j.colegn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Merali K, Karimuddin A, Crump T, Brown C, Phang T, Raval M, Liu G, Sutherland JM. The relationship between perceptions of shared decision-making and patient-reported outcomes in a cross-sectional cohort of haemorrhoidectomy patients. Colorectal Dis 2022; 24:504-510. [PMID: 34985826 DOI: 10.1111/codi.16039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
AIM Shared decision-making between patients and clinicians is important to surgical practice and patients' perceptions of their healthcare experience. This study aims to measure associations between patients' perceptions of their shared decision-making (SDM) process and health-related quality of life among a cohort of patients choosing surgical management of an elective surgical procedure, haemorrhoidectomy. METHODS This study is a single-site study based in Vancouver, Canada. Consecutive patients of five colorectal surgeons registered for elective haemorrhoidectomy between September 2016 and June 2020 were eligible to participate. Participants completed the CollaboRATE instrument which measures patients' perceptions of their SDM after the surgical consultation, along with a number of other patient-reported outcomes. RESULTS The participation rate was 45.3%, with 157 patients scheduled for haemorrhoidectomy providing complete information. Unadjusted results found that participants having the most comorbidities reported better communication with their surgeon. The adjusted results show that socioeconomic status and depression were associated with lower CollaboRATE scores. There was no effect of sex, pain interference, anxiety or perceived health status on participants' CollaboRATE scores. CONCLUSION This study found evidence that participants with lower economic status or those reporting depressive symptoms had worse perceptions of their SDM process with their surgeon. These findings suggest that special attention should be paid to the surgical decision-making process for these patient populations.
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Affiliation(s)
- Khalil Merali
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ahmer Karimuddin
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Carl Brown
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Phang
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manoj Raval
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Guiping Liu
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Nagappa M, Querney J, Martin J, John-Baptiste A, Subramani Y, Lanting B, Schlachta C, Von Koughnett J, Speechley K, Correa J, Yunus Chohan M, Rrafshi N, Batohi M, Fayad A, Yang H. Perioperative satisfaction and health economic questionnaires in patients undergoing an elective hip and knee arthroplasty: A prospective observational cohort study. Anesth Essays Res 2021; 15:413-438. [PMID: 35422546 PMCID: PMC9004266 DOI: 10.4103/aer.aer_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Early hospital discharge shifts the recovery burden toward the patient and can leave patients and their caregivers anxious about the recovery process. Postoperative home care must be broadened to include appropriate and adequate support to address recovery at home. In this prospective study, patient and caregiver perspectives on the level of preparation/satisfaction and cost associated with management of recovery in the postoperative period were evaluated. Methods: We designed this prospective study to measure patient-reported outcomes and to inform the design of a postoperative home monitoring system. Patients undergoing inpatient total hip or knee replacements were recruited from a preadmission clinic at a university hospital. Patients and caregivers completed preoperative, postoperative, and health economic questionnaires. Bivariate analyses were conducted to understand factors associated with satisfaction with care. Results: Of 239 patients and caregivers recruited, preoperative questionnaire was completed by 98.8% of patients, the postoperative follow-up questionnaire was completed by 94.2% of patients, 75% of informal caregivers completed the postoperative follow-up questionnaires, and 93.7% completed the health economic questionnaire. The postoperative satisfaction scores were higher than the preoperative needs/expectation scores for both the overall and individual subscales. Patients undergoing hip arthroplasty reported higher satisfaction scores for postoperative pain management than patients undergoing knee arthroplasty (hip arthroplasty vs. knee arthroplasty: 4.07 ± 1.11 vs. 3.37 ± 1.51; P < 0.001). Patients who underwent knee arthroplasty reported better satisfaction scores with regard to having enough information on how to manage leg stiffness at home compared to patients undergoing hip arthroplasty (knee arthroplasty vs. hip arthroplasty: 3.13 ± 1.35 vs. 2.78 ± 1.30; P = 0.04). Conclusion: Overall, patients are generally satisfied with perioperative care, but they have distinct needs and expectations regarding perioperative medication and postoperative pain management. Virtual postoperative monitoring may be a useful tool during postoperative care to address many of patients’ concerns.
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Rayess N, Li AS, Do DV, Rahimy E. Assessment of Online Sites Reliability, Accountability, Readability, Accessibility, and Translation for Intravitreal Injections. Ophthalmol Retina 2020; 4:1188-1195. [PMID: 32497854 DOI: 10.1016/j.oret.2020.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Patients increasingly use the internet to access health-related information to better understand their treatments. This study compares the quality, accountability, readability, accessibility, and presence of translation between private and academic online source material available to the public regarding intravitreal injections (IVIs). DESIGN Cross-sectional analysis. PARTICIPANTS Top 20 websites on a Google search for the terms eye injections, intravitreal injections, and anti-VEGF injections. METHODS Websites were classified as private or academic. Quality and accountability were assessed using the internationally recognized DISCERN criteria and the Health on the Net Code of Conduct (HONcode). Readability was evaluated using an online tool that provides a consensus readability grade. The presence of and languages available for translation were recorded. MAIN OUTCOME MEASURES The primary outcome measure was a comparison of the DISCERN and HONcode quality and accountability scores between academic and private websites. Secondary outcome measures included evaluating readability, accessibility, and presence of translation (in particular, Spanish). RESULTS Eleven academic and 9 private websites were included. The overall mean score using DISCERN criteria for the academic websites (3.11 ± 0.46) was significantly higher than that of private websites (2.23 ± 0.61; P < 0.007). Similarly, of a possible total of 14 points for the HONcode, the average quality score for academic websites (10.91 ± 2.66) was higher compared with that for private websites (6.44 ± 3.36; P < 0.009). The mean consensus reading grade level was similar between academic (11.73 ± 1.68) and private (11.78 ± 1.48) websites (P = 0.94). Spanish translation was offered by only 7 of the 20 websites (5 academic and 2 private websites). CONCLUSIONS The overall quality and accountability of online content for academic sites was significantly higher compared with that of private websites. Translation was rarely provided, and the readability grade level was significantly higher for both groups than recommended. Improving the quality, accountability, readability, and accessibility and incorporating translation in websites can help to improve patients' health literacy regarding IVIs, potentially leading to increased adherence to therapy plans and improved treatment outcomes.
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Affiliation(s)
- Nadim Rayess
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Angela S Li
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California; Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Diana V Do
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Ehsan Rahimy
- Palo Alto Medical Foundation, Palo Alto, California.
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Afonso AM, Tokita HK, McCormick PJ, Twersky RS. Enhanced Recovery Programs in Outpatient Surgery. Anesthesiol Clin 2019; 37:225-238. [PMID: 31047126 DOI: 10.1016/j.anclin.2019.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although enhanced recovery pathways were initially implemented in inpatients, their principles are relevant in the ambulatory setting. Opioid minimization and addressing pain and nausea through multimodal analgesia, regional anesthesia, and robust preoperative education programs are integral to the success of ambulatory enhanced recovery programs. Rather than measurements of length of stay as in traditional inpatient programs, the focus of enhanced recovery programs in ambulatory surgery should be on improved quality of recovery, pain management, and early ambulation.
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Affiliation(s)
- Anoushka M Afonso
- Enhanced Recovery Programs (ERP), Department of Anesthesiology & Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M-301, New York, NY 10065, USA.
| | - Hanae K Tokita
- Department of Anesthesiology & Critical Care, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Patrick J McCormick
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Rebecca S Twersky
- Department of Anesthesiology & Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1133 York Avenue, Suite 312, New York, NY 10065, USA
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Bayraktar N, Berhuni O, Berhuni MS, Zeki O, Sener ZT, Sertbas G. Effectiveness of Lifestyle Modification Education on Knowledge, Anxiety, and Postoperative Problems of Patients With Benign Perianal Diseases. J Perianesth Nurs 2018; 33:640-650. [PMID: 30236571 DOI: 10.1016/j.jopan.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/12/2017] [Accepted: 03/14/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of preoperative planned education about lifestyle modifications on knowledge, anxiety level, and postoperative problems of the patients with benign perianal disease. DESIGN The study was a quasi-experimental design. METHODS The sample was a total of 102 patients undergoing surgical procedure for hemorrhoid and fissure in the general surgery unit of a state hospital in Turkey. Data were collected using the Descriptive Characteristics Determination Questionnaire, the Knowledge Determination Questionnaire, the Postoperative Problems Determination Questionnaire, and the State and Trait Anxiety Inventory. FINDINGS Preoperative written and verbal planned education about lifestyle modifications improved knowledge and decreased anxiety levels of the patients. There were no statistically significant differences between the control and study groups in postoperative problems other than leakage. CONCLUSIONS Results of the present study showed that nurse-conducted education on lifestyle modification of hemorrhoid and fissure was effective.
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Xia W, Barazanchi AWH, MacFater W, Sammour T, Hill AG. Day case versus inpatient stay for excisional haemorrhoidectomy. ANZ J Surg 2018; 89:E5-E9. [DOI: 10.1111/ans.14838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/06/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Weisi Xia
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital; The University of Auckland; Auckland New Zealand
| | - Ahmed W. H. Barazanchi
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital; The University of Auckland; Auckland New Zealand
| | - Wiremu MacFater
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital; The University of Auckland; Auckland New Zealand
| | - Tarik Sammour
- Colorectal Unit, Department of Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Andrew G. Hill
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital; The University of Auckland; Auckland New Zealand
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Nicholson Thomas E, Edwards L, McArdle P. Knowledge is Power. A quality improvement project to increase patient understanding of their hospital stay. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:u207103.w3042. [PMID: 28321297 PMCID: PMC5337670 DOI: 10.1136/bmjquality.u207103.w3042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/09/2016] [Indexed: 11/03/2022]
Abstract
Patients frequently leave hospital uninformed about the details of their hospital stay with studies showing that only 59.9% of patients are able to accurately state their diagnosis and ongoing management after discharge. 1 2 This places patients at a higher risk of complications. Educating patients by providing them with accurate and understandable information enables them to take greater control, potentially reducing readmission rates, and unplanned visits to secondary services whilst providing safer care and improving patient satisfaction. 3 4 We wished to investigate whether through a simple intervention, we could improve the understanding and retention of key pieces of clinical information in those patients recently admitted to hospital. A leaflet was designed to trigger patients to ask questions about key aspects of their stay. This was then given to inpatients who were interviewed two weeks later using telephone follow up to assess their understanding of their hospital admission. Patients were asked about their diagnosis, new medications, likely complications, follow up arrangements and recommended points of contact in case of difficulty. Sequential modifications were made using PDSA cycles to maximise the impact and benefit of the process. Baseline data revealed that only 77% of patients could describe their diagnosis and only 27% of patients knew details about their new medications. After the leaflet intervention these figures improved to 100% and 71% respectively. Too often patients are unaware about what happens to them whilst in hospital and are discharged unsafely and dissatisfied as a result. A simple intervention such as a leaflet prompting patients to ask questions and take responsibility for their health can make a difference in potentially increasing patient understanding and thereby reducing risk.
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Fernando RJ, Shapiro FE, Urman RD. Survey Analysis of an Ambulatory Surgical Checklist for Patient Use. AORN J 2016; 102:290.e1-10. [PMID: 26323231 DOI: 10.1016/j.aorn.2015.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/22/2015] [Accepted: 07/24/2015] [Indexed: 01/18/2023]
Abstract
Although checklists are used as tools for providers, they have not been adequately explored as tools for patients. The purpose of this study was to survey the stakeholders on the usefulness of an ambulatory surgical checklist for patients. We performed a cross-sectional study through a survey designed to include both patients and providers. Descriptive analysis of the data was performed based on responses from 35 patients and 52 providers. Overall, 94% of patients and 83% of providers thought the checklist would be beneficial for patients. In addition, 37% of providers indicated potential barriers to checklist implementation, including fear of confusing the patient, making patients doubt the care they were receiving, taking too much time, and lack of resources. Based on survey responses, the study suggests that the ambulatory surgical checklist can potentially facilitate patient education, enable more active patient participation, increase patient satisfaction, and decrease patient anxiety.
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Shaw D, Ternent CA. Perioperative Management of the Ambulatory Anorectal Surgery Patient. Clin Colon Rectal Surg 2016; 29:7-13. [PMID: 26929746 PMCID: PMC4755778 DOI: 10.1055/s-0035-1570023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ambulatory surgery is appropriate for most anorectal pathology. Ambulatory anorectal surgery can be performed at reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids. Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions.
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Affiliation(s)
- Darcy Shaw
- Colon and Rectal Surgery Inc., Omaha, Nebraska
| | - Charles A. Ternent
- Department of Surgery, Section of Colon and Rectal Surgery, Creighton University School of Medicine, Omaha, Nebraska
- Department of Surgery, Department of Surgery, University of Nebraska College of Medicine, Omaha, Nebraska
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Pearce S. Communication, teamwork, and trust in an office-based practice. AORN J 2014; 101:144-8. [PMID: 25537334 DOI: 10.1016/j.aorn.2014.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/13/2014] [Indexed: 11/18/2022]
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Manohar A, Cheung K, Wu CL, Stierer TS. Burden incurred by patients and their caregivers after outpatient surgery: a prospective observational study. Clin Orthop Relat Res 2014; 472:1416-26. [PMID: 24005979 PMCID: PMC3971218 DOI: 10.1007/s11999-013-3270-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The burden of patients and their caregivers after outpatient surgery has not been fully examined. The number of outpatient surgeries has dramatically increased in the last several years, particularly in the orthopaedic sector. Patients undergoing outpatient orthopaedic procedures may be expected to have more postdischarge pain than those undergoing nonorthopaedic outpatient procedures. In light of this, assessment of patient and caregiver expectations and actual burden after discharge is of importance. QUESTIONS/PURPOSES We assessed the impact of outpatient surgery on recovery of patients and their caregivers in the postoperative period by determining (1) expected versus actual time to resume daily activities, including work; (2) expected versus actual recovery at 7 and 30 days postoperatively; and (3) the number of caregivers that felt emotional or physical disturbances from caring for outpatients. METHODS Forty-four adult patients undergoing outpatient surgical procedures and their primary caregivers were enrolled in this prospective survey study, of which 30% were orthopaedic patients. Surveys assessing postoperative recovery were given to patients at six time points, on Postoperative Days 0 to 3, 7, and 30. Surveys assessing the burden of informal caregiving were given to each patient's primary caregiver at four time points, on Postoperative Days 1 to 3 and 7. The enrollment rate was 79% (44 enrolled of 56 approached) and the survey response rate was 100% for patients and 93% (41 of 44) for caregivers. RESULTS We found that 16 of 44 patients (36%) needed more time than originally anticipated to resume their daily activities and three of 29 patients (10%) needed more time off from work than originally anticipated. Patients were approximately 66% and 88% fully recovered 7 and 30 days after surgery, respectively. The primary caregivers noted disturbances in emotional (nine of 43, 21%) and physical (17 of 43, 40%) aspects of their daily lives while providing care for patients. Our surveyed patients were from multiple surgical services; however, our results may be generalized to an orthopaedic population, although they may underestimate actual results for this population given their generally higher pain scores. CONCLUSIONS Patients may take longer to recover from outpatient surgery than previously recognized. As increased pain and prolonged recovery may be associated with increased caregiver burden, these data are of particular significance to the outpatient orthopaedic surgical population. Informal caregiving after outpatient surgery may be an unrecognized physical and psychologic burden and may have a significant societal impact. LEVEL OF EVIDENCE Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Asha Manohar
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Kristin Cheung
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Christopher L. Wu
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Tracey S. Stierer
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD 21287 USA
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