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Patients’ perspectives on recovery from day surgery
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A large number of elective surgical patients in Sweden and elsewhere have their surgical procedure performed in a day surgery context. The surgical care event, with its postoperative surveillance, is brief at the surgery unit and patients are discharged home with the intention that they should manage postoperative recovery mainly themselves. However, several patients attest to being in an exposed situation when assuming responsibility for recovery at home. The overall aim of this thesis was to attain comprehensive knowledge of postoperative recovery following day surgery from a patient perspective.

A questionnaire, the Post-discharge Surgical Recovery scale, was translated into Swedish and evaluated regarding its psychometric properties in a Swedish context. A sample of 607 day surgery patients who had undergone orthopaedic, general or gynaecological surgery self-rated their recovery at postoperative Days 1, 7 and 14 using the Post-discharge Surgical Recovery scale and the Quality of Recovery-23. Health-related quality of life was assessed before and 30 days after the surgical procedure, using the EQ-5D. In a second sample, 31 patients were interviewed in their homes regarding their recovery after day surgery. The interviews were conducted on postoperative Days 11-37, and focused on the meaning of recovery, self-care and perceptions of recovery. Data were explored by means of a phenomenographic analysis.

The Post-discharge Surgical Recovery scale showed satisfactory psychometric properties when used among Swedish day surgery patients. Following discharge, recovery included both physical and emotional perspectives. Recovery varied, and influencing factors were found to be type of surgery, age, perceived health and emotional status on the first postoperative day. Orthopaedic patients had a more protracted recovery process compared to general surgery and gynaecological patients, along with more postoperative pain and lower health-related quality of life. Patients perceived that postoperative recovery comprised different internal and external factors and a large amount of responsibility regarding their recovery and surgical outcome. To be prepared for recovery at home, patients wanted knowledge and understanding about the normal range of recovery following their specific surgical procedure, and needed support from different sources in their surroundings.

This thesis provides insight into day surgery patients’ postoperative situation. Based on the studies, individualized and well thought-out support appears favourable in order to have confident and well prepared patients at home. In contrast to smooth and easy patient care at the surgery unit, the postoperative phase seems to be a weak link in the day surgical continuity of patient care. Postoperative care needs to be further improved to increase quality and patients’ overall satisfaction with the day surgical experience. Attention should be paid to patients’ physical and emotional resources and needs.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. , 80 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1330
Keyword [en]
Ambulatory surgical procedures, continuity of patient care, recovery of function, self care, qualitative research, quality of life, questionnaires, validation studies
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-85027ISBN: 978-91-7519-793-7 (print)OAI: oai:DiVA.org:liu-85027DiVA: diva2:563657
Public defence
2012-11-30, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2016-09-26Bibliographically approved
List of papers
1. Psychometric evaluation of the post-discharge surgical recovery scale
Open this publication in new window or tab >>Psychometric evaluation of the post-discharge surgical recovery scale
Show others...
2010 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, 794-801 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patients recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbachs alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearsons correlation coefficient. Patients ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbachs coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd, 2010
Keyword
day surgery; postoperative period; psychometrics; questionnaire; recovery; validation study
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-58188 (URN)10.1111/j.1365-2753.2009.01197.x (DOI)000279901700019 ()
Note

This is the authors’ version of the following article: Katarina Berg, Ewa Idvall, Ulrica Nilsson, Kristofer Franzén Årestedt and Mitra Unosson, Psychometric evaluation of the post-discharge surgical recovery scale, 2010, Journal of Evaluation In Clinical Practice, (16), 4, 794-801. which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2753.2009.01197.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.html

Available from: 2010-08-11 Created: 2010-08-09 Last updated: 2017-12-12Bibliographically approved
2. Postoperative recovery after different orthopedic day surgical procedures
Open this publication in new window or tab >>Postoperative recovery after different orthopedic day surgical procedures
2011 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 15, no 4, 165-175 p.Article in journal (Refereed) Published
Abstract [en]

Orthopedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to 2 weeks after different orthopedic day surgical procedures and tried to identify possible predictors associated with recovery. Three-hundred and fifty eight patients who had undergone knee arthroscopy or surgery to the hand/arm, foot/leg or shoulder were included. Data were collected on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23 and a general health question. Multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health 1 and 2 weeks after surgery compared to the other patient groups (p < 0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day and type of surgery. Postoperative recovery after common orthopedic day surgical procedures varies and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2011
Keyword
Day surgery; Postoperative recovery; Orthopedic nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-71363 (URN)10.1016/j.ijotn.2011.02.003 (DOI)
Available from: 2011-10-13 Created: 2011-10-13 Last updated: 2017-12-08
3. Postoperative recovery and its association with health-related quality of life among day surgery patients
Open this publication in new window or tab >>Postoperative recovery and its association with health-related quality of life among day surgery patients
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge. A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.

Results: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

Conclusion: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

Keyword
Ambulatory surgical procedures, nursing, quality of life, recovery of function
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-85025 (URN)
Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2016-09-26Bibliographically approved
4. Postoperative recovery from the perspective of day surgery patients: A phenomenographic study
Open this publication in new window or tab >>Postoperative recovery from the perspective of day surgery patients: A phenomenographic study
2013 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, 1630-1638 p.Article in journal (Refereed) Published
Abstract [en]

Background: Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patient’s own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home.

Objectives: To explore day surgery patients’ perceptions of postoperative recovery.

Design: A qualitative design with a phenomenographic approach was used.

Methods and settings: Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face-to-face at the patients’ homes, 11-37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital.

Results: The patients perceived postoperative recovery as comprising internal and external prerequisites and implied changes in ordinary life with varying levels of support. The organization at the day surgery unit, with its advantages and disadvantages, was perceived as having an impact on the subsequent recovery trajectory. The results are demonstrated in three descriptive categories: ‘Conditions for recovery at home’, The rollback to ordinary life’ and ‘Being a cog in a flow of care’.

Conclusions: Postoperative recovery following day surgery implies, from the patients’ perspective, a migration from being a recipient of care at the day surgery unit to playing an active role, with extensive responsibility at home. To manage self-care confidently, postdischarge patients require knowledge and understanding of what constitutes the normal range in recovery following their specific surgical procedure.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Ambulatory surgical procedures, nursing, qualitative research, recovery of function, self care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-85026 (URN)10.1016/j.ijnurstu.2013.05.002 (DOI)000327225300007 ()
Note

Funding agencies|ALF||County Council of Ostergotland, Sweden||Linkoping University||

Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2017-12-07Bibliographically approved

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