Postoperative recovery and its association with health-related quality of life among day surgery patients

Healing beyond bone: a qualitative study of the core decompression experience of physically active patients with stage II hip avascular necrosis

BACKGROUND

Avascular necrosis (AVN) of the femoral head is a degenerative condition characterized by ischemic bone death, resulting in pain and impaired mobility. Core decompression, a surgical intervention, is widely performed for stage II AVN to alleviate symptoms and delay disease progression. While clinical and radiological outcomes are well-documented, the psychosocial dimensions of recovery remain underexplored. This study aims to understand the experiences of physically active patients diagnosed with stage II AVN who have undergone core decompression surgery during their follow-up period, allowing for a broader evaluation of the experiences of this patient group.

METHODS

This study used semi-structured interviews, in-depth follow-up questions, and thematic analysis to explore the experiences of physically active patients who underwent core decompression surgery for stage II AVN of the femoral head. The participants were assessed 1-3 years post-surgery. Conducted in the Orthopaedics and Traumatology outpatient clinic of Adana City Training and Research Hospital, the study included 31 patients who had core decompression surgery between January 2020 and January 2024, with at least one year of follow-up data. Data collection, including demographic and qualitative information, was carried out during the first week of April 2024, followed by the member-checking process in the third week. A thematic analysis checklist and COREQ guidelines were used to ensure analysis reliability.

RESULTS

The experiences of 31 patients (mean age 37.19 ± 8.21 years, 12 females, 19 males) were summarized into five main themes that emerged from the data analysis process: 'Expectations and Concerns Before Surgery,' 'Postoperative Physical Experiences,' 'The Psychological and Emotional Process,' 'Social Support and Family Relationships,' and 'Health Services and Medical Support.'' Twelve sub-themes emerged from the main themes.

CONCLUSIONS

Core decompression offers significant benefits to patients with stage II AVN by improving mobility and reducing pain. However, psychological support, patient education, and robust social networks are essential to address the holistic needs of recovery. These findings highlight the importance of integrating patient-centered approaches into surgical care to optimize outcomes and satisfaction. Further qualitative research is needed to explore the experiences of AVN patients at different stages to inform multidisciplinary care strategies.

Assessment of intermediate phase post anesthesia quality of recovery and its affecting factors

BACKGROUND

Recovery after surgery and anesthesia is dependent on patient, surgical, and anesthetic characteristics, as well as the presence of any of numerous adverse sequelae. Postoperative recovery is a complex and multidimensional process that requires a holistic view of the recovery of capacities and homeostasis after anesthesia and surgery.

OBJECTIVE

To assess the quality of recovery after anesthesia and its affecting factors at Wachamo University Nigist Eleni Mohamed Memorial Comprehensive Hospital.

METHOD

a prospective observational study was conducted at Wachamo University Nigist Eleni Mohamed Memorial Comprehensive Hospital among 384 surgical patients who undergone under anesthesia. Quality of recovery was assessed by using Quality of Recovery 40. Student t-test and one-way ANOVA were utilized to compare the mean of Quality of recovery in different groups. Binary regression was used to find out the factors affecting Quality of recovery quality of recovery. SPSS 27 was used for analysis. A p-value of < 0.05 was considered statistically significant.

RESULT

Sex and smoking history were the factors that we failed to find an association with poor quality of recovery. Preoperative antiemetic administration; premedication with benzodiazepines and emergency procedures were the factors that show potential relation with poor quality of recovery after anesthesia and surgery. Procedures performed under general anesthesia; Patients who had coexisting diseases; post-anesthesia incidence of nausea and vomiting; Visual Analog Scale score >/= 7 during discharge and prolonged duration of surgery were the factors that had a significant association with poor quality of recovery.

CONCLUSION

The magnitude of good quality of recovery was 65.6% whereas 34.4% scored poor quality of recovery. The predictors for the prevalence of poor quality of recovery were found to be orthopedic procedures; procedures undergone under general anesthesia; incidence of post-anesthesia nausea and vomiting; prolonged length of the procedure and severity of pain.

The Efficacy of Probiotics, Prebiotics, and Synbiotics in Patients Who Have Undergone Abdominal Operation, in Terms of Bowel Function Post-Operatively: A Network Meta-Analysis

BACKGROUND

Abdominal operations may lead to post-operative bowel dysfunction, while administration of probiotics, prebiotics and synbiotics may limit its manifestation. Τhe study aimed to assess the efficacy of probiotics, prebiotics and synbiotics in patients who undergone abdominal operation, in terms of bowel function post-operatively.

METHODS

PubMed, Scopus, Cochrane Central Register of Controlled Trials (Central), Embase, US Registry of clinical trials, and sources of grey literature were searched. The relative effect sizes were estimated, and we obtained the relative ranking of the interventions using cumulative ranking curves.

RESULTS

In total, 30 studies were included in the analysis. For the outcome of post-operative ileus, probiotics was superior to placebo/no intervention (relative risk, RR: 0.38; 95%CI: 0.14-0.98) with the highest SUCRA (surface under the cumulative ranking) value (92.1%). For time to first flatus, probiotics (MD: -0.47; 95%CI: -0.78 to -0.17) and synbiotics (MD: -0.53; 95%CI: -0.96 to -0.09) were superior to placebo/no intervention. For time to first defecation and for post-operative abdominal distension probiotics were superior to placebo/no intervention. For post-operative hospitalization days, synbiotics were superior to placebo/no intervention (MD: -3.07; 95%CI: -4.80 to -1.34).

CONCLUSIONS

Administration of probiotics in patients who had undergone abdominal surgery reduced the prevalence of post-operative ileus, time to first flatus, time to first defecation, and prevalence of post-operative abdominal distension. Synbiotics reduce time to first flatus and post-operative hospitalization days.

Preoperative patients' quality of life and outcomes after colorectal surgery: A prospective study

The aim of this prospective study was to assess the influence of preoperative life satisfaction on objective and subjective outcomes after elective colorectal surgery. Preoperative life satisfaction was assessed using a validated questionnaire (Échelle de Mesure des Manifestations du Bien-Être Psychologique). Postoperative quality of life was assessed by the Cleveland Global Quality of Life and QLQ-C30. Number of footsteps was recorded from preoperative day 5 to postoperative day 3. Physical activity, length of stay, and complications were compared between patients with low and high preoperative life satisfaction. Fifty patients were included. There was no difference between the 2 groups concerning postoperative objective (length of stay, complications, and number of footsteps) and subjective (Cleveland Global Quality of Life and QLQ-C30) recovery. In conclusion, preoperative life satisfaction of colorectal surgery patients had no influence on outcomes and physical activity in colorectal surgery.

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.

Device Adjustment and Recovery in Patients With Heart Failure Undergoing a Cardiac Resynchronization Therapy Implantation: A Longitudinal Study

BACKGROUND

Little is known about risk factors for poor adjustment to the device after cardiac resynchronization therapy (CRT) implantation in patients with heart failure.

PURPOSE

The aim of this study was to explore device adjustment and the postoperative recovery of patients with heart failure undergoing elective CRT device implantation.

METHODS

In this prospective multicenter longitudinal study, data were collected before implantation and after 2 weeks, 6 months, and 1 year, using validated self-reported instruments and investigator-designed, CRT-specific questions.

RESULTS

A total of 133 patients, 79% male, with a mean age of 70 ± 10 years, were included. Patients adjusted to the device over time (P < .001), but 20% of patients had difficulties after 2 weeks, and 11% had difficulties at the 1-year follow-up. Fatigue was the most common health problem before surgery (87%), which was reduced to 65% after 1 year, P < .001. Patients' recovery improved over time (P < .001). Device-specific problems with hiccups (7% vs 14%), pulsation around the device (29% vs 24%), tachycardia (28% vs 29%), appearance of the scar (21% vs 17%), and the device bulging out (65% vs 61%) remained unchanged over time, whereas stiffness in the shoulder (64% vs 28%, P < .001) and wound healing (9% vs 2%, P < .05) improved.

CONCLUSIONS

Most patients with heart failure recover and adjust early after their CRT implantation and improve even more during follow-up. However, recovery and adjustment are problematic for some patients, and many experience bodily discomforts because of the device. Early screening for poor adjustment and psychological distress can lead to appropriate interventions and timely referrals. This is important in the era of remote monitoring with less face-to-face contact.

One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial

Background/Objectives

This study aimed to study one-month recovery profile and to identify predictors of Quality of Recovery (QOR) after painful day surgery and investigate the influence of pain therapy on QOR.

Methods/Design

This is a secondary analysis of a single-centre, randomised controlled trial of 200 patients undergoing ambulatory haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair between January 2016 and March 2017. Primary endpoints were one-month recovery profile and prevalence of poor/good QOR measured by the Functional Recovery Index (FRI), the Global Surgical Recovery index and the EuroQol questionnaire at postoperative day (POD) 1 to 4, 7, 14 and 28. Multiple logistic regression analysis was performed to determine predictors of QOR at POD 7, 14, and 28. Differences in QOR between pain treatment groups were analysed using the Mann-Whitney U test.

Results

Four weeks after haemorrhoid surgery, inguinal hernia repair, arthroscopic knee and arthroscopic shoulder surgery, good QOR was present in 71%, 76%, 57% and 24% respectively. Poor QOR was present in 5%, 0%, 7% and 29%, respectively. At POD 7 and POD 28, predictors for poor/intermediate QOR were type of surgery and a high postoperative pain level at POD 4. Male gender was another predictor at POD 7. Female gender and having a paid job were also predictors at POD 28. Type of surgery and long term fear of surgery were predictors at POD 14. No significant differences in total FRI scores were found between the two different pain treatment groups.

Conclusions

The present study shows a procedure-specific variation in recovery profile in the 4-week period after painful day surgery. The best predictors for short-term (POD 7) and long-term (POD 28) poor/intermediate QOR were a high postoperative pain level at POD 4 and type of surgery. Different pain treatment regimens did not result in differences in recovery profile.

Trial registration

European Union Clinical Trials Register 2015-003987-35.

Associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among Swedish orthopaedic patients

BACKGROUND

The evaluation of one's physical health and psychological wellbeing may be subjective. Aspects of functional capacity, including the patients' own estimation of physical health and wellbeing, have been shown to be strong predictors of postoperative outcomes and should be the focus of further research.

AIM

This study aimed to explore the associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among orthopaedic patients.

METHODS

This was a longitudinal study using a quantitative approach.

SETTINGS

A central county hospital in northern Sweden.

RESULTS

A high ASA classification rated by anaesthetists was not associated with physical health and psychological wellbeing self-estimated as less than good. A high ASA classification was significantly associated with self-estimated anxiety prior to surgery. Three days and one month post-surgery, the situation was reversed, and the ASA I/II group, to a significantly higher extent, rated that they felt anxiety.

CONCLUSION

Preoperative screening systems for orthopaedic patients should not only focus on the medical and objective physical issues but also include the patients' own estimation of their physical health and psychological wellbeing. It is essential that orthopaedic patients receive relevant information that provides a realistic outlook, as well as an honest and optimistic future view.

Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives

The management of postoperative pain is of critical importance for women undergoing breast reconstruction after surgical treatment for breast cancer. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Multimodal analgesia pain management strategies with nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery. Regional anesthesia techniques, with paravertebral blocks (PVBs) and transversus abdominis plane (TAP) blocks, and enhanced recovery after surgery (ERAS) pathways have been increasingly utilized in opioid-sparing multimodal analgesia protocols for women undergoing breast reconstruction. The objectives of this review are to 1) comprehensively review regional anesthesia techniques in breast reconstruction, 2) outline important components of ERAS protocols in breast reconstruction, and 3) provide evidence-based recommendations regarding each intervention included in these protocols. The authors searched across six databases to identify relevant articles. For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize perioperative care and postoperative pain control in breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in breast reconstruction.

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)

Pain-related unscheduled contact with healthcare services after outpatient surgery

This prospective, observational study explored the need for pain-related unscheduled contact with healthcare services after outpatient surgery. We hypothesised that 10% of outpatients would have pain-related unscheduled contact with healthcare services, and that the incidence would differ depending on the type of surgical procedure. In total, 905 patients who had undergone one of five common outpatient surgical procedures (knee or shoulder arthroscopy, surgical correction of hallux valgus, laparoscopic cholecystectomy or laparoscopic gynaecological procedures) completed an electronic questionnaire one week and eight weeks after surgery. Data from 732 patients (81%) were available for analysis. Within the first eight weeks after surgery, 150 patients (20.5%) had made unscheduled contact with healthcare professionals, in 247 cases due to pain that was most frequent in the first postoperative week. Risk factors were female sex, unemployment and laparoscopic cholecystectomy. The most frequent healthcare contact was with the general practitioner (46.4%), and the most frequent outcome was further information and guidance (41.2%). We have demonstrated that a minority of patients still needed to make contact with health services after outpatient surgery, most often due to inadequate pain management. This finding should be considered when planning postoperative monitoring and care, and developing postoperative patient education.

Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy: A Randomized Study

PURPOSE

The purpose of this study was to compare two anesthetic techniques for postoperative pain after ambulatory operative hysteroscopy.

DESIGN

A randomized trial.

METHODS

Women (N = 153) scheduled for ambulatory operative hysteroscopy were assigned to receive either paracervical local anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale.

FINDING

Data from 144 patients were available for analysis (LA + S: n = 69; GA: n = 75). There were no significant differences in worst pain intensity between groups in the PACU (P = .13) or after discharge from PACU (P = .40). In group LA + S, fewer patients received treatment with intravenous fentanyl intraoperatively (P < .01) and time until discharge from PACU was shorter (P < .01). More patients in group LA + S experienced vomiting after discharge (P < .05).

CONCLUSIONS

Local anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy.

Prevalence and Predictors of Quality of Recovery at Home After Day Surgery

Traditionally, major complications and unanticipated admission/readmission rates were used to assess outcome after day surgery. However, in view of the relative absence of major complications the quality of recovery (QOR) should be considered one of the principal endpoints after day surgery. In our study, the level of QOR is defined by a combination of the Global Surgical Recovery (GSR) Index and the Quality of Life (QOL). The aim of this study was to analyze prevalence and predictors of QOR after day surgery on the fourth postoperative day. Elective patients scheduled for day surgery from November 2008 to April 2010 were enrolled in a prospective cohort study. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. Primary outcome parameter is the QOR and is defined as good if the GSR index >80% as well as the postoperative QOL is unchanged or improved as compared with baseline. QOR is defined as poor if both the GSR index ≤ 80% and if the postoperative QOL is decreased as compared with baseline. QOR is defined as intermediate in all other cases. Three logistic regression analyses were performed to determine predictors for poor QOR after day surgery. A total of 1118 patients were included. A good QOR was noted in 17.3% of patients, an intermediate QOR in 34.8%, and a poor QOR in 47.8% 4 days after day surgery. The best predictor for poor QOR after day surgery was type of surgery. Other predictors were younger age, work status, and longer duration of surgery. A history of previous surgery, expected pain (by the patient) and high long-term surgical fear were significant predictors of poor QOR in only 1 of 3 prediction models. The QOR at home 4 days after day surgery was poor in the majority of patients and showed a significant procedure-specific variation. Patients at risk for poor QOR can be identified during the preoperative period based on type of surgery, age, work status, and the duration of the surgery.