Low Preoperative Mental and Physical Health is Associated with Poorer Postoperative Recovery in Patients Undergoing Day Surgery: A Secondary Analysis from a Randomized Controlled Study

Understanding neurocognitive recovery in older adults after total hip arthroplasty-neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study

OBJECTIVE

Delayed neurocognitive recovery, previously known as postoperative cognitive dysfunction, is a common complication affecting older adults after surgery. This study aims to address the knowledge gap in postoperative neurocognitive recovery by exploring the relationship between subjective experiences, performance-based measurements, and blood biomarkers.

DESIGN

Mixed-methods study with a convergent parallel (QUAL+quan) design.

SETTING AND PARTICIPANTS

The study reports results from 40 older adult patients (52.5% women; mean age 73, SD 6.7) scheduled for total hip arthroplasty at a hospital in Sweden.

OUTCOME MEASURES

Neurocognitive performance was assessed using a standardised test battery, neuroinflammation through blood biomarker analysis and postoperative neurocognitive recovery via semistructured interviews and the Swedish Quality of Recovery questionnaire.

RESULTS

Five patients were classified as having delayed neurocognitive recovery based on performance tests. Qualitative data revealed that most patients reported cognitive symptoms, particularly related to executive functions and fatigue. Psychological factors, including a sense of agency and low mood, significantly influenced cognitive recovery and daily functioning. Elevated inflammatory blood biomarkers were not detected pre- or postoperatively in patients with delayed neurocognitive recovery. The global postoperative recovery score was 40.9, indicating a low quality of recovery.

CONCLUSION

Many patients reported subjective cognitive decline that was not corroborated by delayed neurocognitive recovery in the performance-based tests. Psychological factors were influential for neurocognitive recovery and should be routinely assessed. Future research should incorporate longitudinal follow-ups with performance-based measurements, fatigue assessment, evaluations of instrumental activities of daily living and subjective reporting, supported by a multidisciplinary team approach.

TRIAL REGISTRATION NUMBER

NCT05361460.

Prioritising mental health in the perioperative period: understanding postoperative patterns in anxiety and depression through ecological momentary assessment

A recent study in the British Journal of Anaesthesia examining trajectories of anxiety and depressive symptoms after diverse surgical procedures sheds light on an often overlooked, yet important, factor in postoperative recovery-mental health. The authors applied ecological momentary assessment to collect high-resolution data to identify and characterise a subgroup of vulnerable patients who experience worsening of psychological symptoms after surgery. The study prompts not only consideration of psychological factors, but also how best to leverage ecological momentary assessment to understand the perioperative experience.

Assessing Preoperative (EORTC) QLQ-C30 Score in Elderly Patients with Colorectal Cancer: Results from a Prospective Cohort Study

Background: In the present study, we aimed to investigate the association between (EORTC) QLQ-C30 scores and both preoperative somatometric parameters and postoperative outcomes in elderly patients undergoing elective surgery for resectable colorectal cancer. Methods: The 118 elderly consecutive patients who underwent colorectal surgery for cancer in a single university's surgical department between 01/2018 and 12/2018 were prospectively enrolled in the present study. All patients with an age > 65 years, diagnosed with resectable colorectal cancer, without metastatic disease, that underwent elective surgery were included prospectively in the present study. Results: Regarding patients' characteristics, a negative correlation between preoperative QLQ (pQLQ) score and age (p = 0.001) and a positive correlation between body mass index (BMI) and pQLQ score (p = 0.048) were observed. Furthermore, there was a statistically significant difference (p = 0.004) in the mean pQLQ score between patients with rectal or colon cancer. Moreover, assessing pQLQ score was a useful tool in terms of postoperative recovery. Negative correlations between the pQLQ score and time (days) of beginning oral feeding (p < 0.001) and length of hospital stay (p = 0.004) were found. The pQLQ score was statistically significantly lower (p = 0.005) in patients who had any postoperative complication; however, there was no difference in patients with major complications. Conclusions: Advanced age, colon cancer and decreased BMI were negatively associated with preoperative QLQ. The assessment of pQLQ in elderly patients with colorectal cancer can be a useful predictive tool for postoperative complications, length of hospital stay and postoperative rehabilitation.

Increasing handgrip strength via post-hypnotic suggestions with lasting effects

In our study, we suggested participants to feel strong during hypnosis and tested if that affected their handgrip strength. Handgrip strength is measured via a hand dynamometer and indicates muscle strength and participants' general medical condition. In addition, we obtained subjective ratings of strength via a visual analogue scale. We developed a hypnosis intervention to increase strength and tied the feeling of strength to a post-hypnotic power anchor. Participants could activate this power anchor afterwards to feel strong again. We also had a randomized control group that read Arnold Schwarzenegger's autobiography instead of hypnosis. We tested the effect of the post-hypnotic power anchor on two experimental sessions separated by one week. Our data show that participants in the hypnosis group felt significantly stronger when they activated their post-hypnotic power anchor compared to their own baseline, both in the first and second experimental session. In addition, participants in the hypnosis group showed a significant increase in objective handgrip strength compared to their own baseline one week after the hypnosis session. We conclude that our hypnosis intervention primarily improved strength perception and secondary objective handgrip strength. Our intervention can help patients to improve their medical condition and athletes to improve their sport performance.

Classification Into Different Patient Groups-A Step Toward Tailoring Care After Major Oncological Surgery?

Objective

To evaluate how the distribution of patients in groups (based on subjective health experience) changes over time and to investigate differences in physical functioning and mental health between these patient groups.

Design

An observational cohort study.

Setting

University medical center.

Participants

Patients who underwent gastrointestinal or bladder oncological surgery (N=98).

Interventions

Not applicable.

Main Outcome Measures

The classification of patients into different groups based on the subjective health experience model (acceptance and perceived control), preoperatively and 1 and 3 months after discharge.

Results

In total, 98 patients were included. Preoperatively, 31% of the patients were classified as having low acceptance and perceived control (group 4), and this proportion increased to 47% and 45% 1 and 3 months after discharge, respectively. These patients had significantly lower levels of physical functioning (preoperatively, 55 vs 61; P=.030; 1 month, 47 vs 57; P=.002; 3 months, 52 vs 62; P=.006) and higher levels of anxiety and depression (preoperatively, 14 vs 9; P<.001; 1 month, 11 vs 3; P=.001; 3 months, 10 vs 3; P=.009) than patients with high acceptance and perceived control (group 1).

Conclusions

The classification of patients to different groups provides insight in different levels of physical and mental health. However, frequent evaluation is important because of changes in patient groups over time.

Sociodemographic and Psychosocial Factors Affecting the Psychological Well-Being of Preoperative Surgical Patients

PURPOSE

This study aimed to determine the subjective psychological well-being levels and sociodemographic and psychosocial factors affecting the psychological well-being of preoperative surgical patients.

DESIGN

This was a cross-sectional study.

METHODS

This study was conducted between January 15, 2021 and July 15, 2021. The sample consisted of 236 surgical patients in a public hospital in the Thrace region of Turkey. Data were collected using a personal information form and the five-item World Health Organization Well-Being Index (WHO-5). The data were analyzed using numbers, percentages, mean, standard deviation, independent samples t test, one-way analysis of variance, Tukey's multiple comparison test, and linear regression analysis.

FINDINGS

Participants had a mean WHO-5 score of 10.76 ± 6.21, indicating low subjective psychological well-being. Economic status, chronic disease status, history of surgery, having been on psychiatric medication or receiving professional psychological support, tobacco use, experiencing a significant life change in the last 3 months, and reporting experiencing frequent stress in everyday life were significant predictors of WHO-5 scores.

CONCLUSIONS

Preoperative surgical patients have low subjective psychological well-being, and their sociodemographic and psychosocial factors affect their psychological well-being.

Impact of perioperative low-molecular-weight heparin therapy on clinical events of elderly patients with prior coronary stents implanted > 12 months undergoing non-cardiac surgery: a randomized, placebo-controlled trial

BACKGROUND

Little is known about the safety and efficacy of discontinuing antiplatelet therapy via LMWH bridging therapy in elderly patients with coronary stents implanted for > 12 months undergoing non-cardiac surgery. This randomized trial was designed to compare the clinical benefits and risks of antiplatelet drug discontinuation via LMWH bridging therapy.

METHODS

Patients were randomized 1:1 to receive subcutaneous injections of either dalteparin sodium or placebo. The primary efficacy endpoint was cardiac or cerebrovascular events. The primary safety endpoint was major bleeding.

RESULTS

Among 2476 randomized patients, the variables (sex, age, body mass index, comorbidities, medications, and procedural characteristics) and percutaneous coronary intervention information were not significantly different between the bridging and non-bridging groups. During the follow-up period, the rate of the combined endpoint in the bridging group was significantly lower than in the non-bridging group (5.79% vs. 8.42%, p = 0.012). The incidence of myocardial injury in the bridging group was significantly lower than in the non-bridging group (3.14% vs. 5.19%, p = 0.011). Deep vein thrombosis occurred more frequently in the non-bridging group (1.21% vs. 0.4%, p = 0.024), and there was a trend toward a higher rate of pulmonary embolism (0.32% vs. 0.08%, p = 0.177). There was no significant difference between the groups in the rates of acute myocardial infarction (0.81% vs. 1.38%), cardiac death (0.24% vs. 0.41%), stroke (0.16% vs. 0.24%), or major bleeding (1.22% vs. 1.45%). Multivariable analysis showed that LMWH bridging, creatinine clearance < 30 mL/min, preoperative hemoglobin < 10 g/dL, and diabetes mellitus were independent predictors of ischemic events. LMWH bridging and a preoperative platelet count of < 70 × 109/L were independent predictors of minor bleeding events.

CONCLUSIONS

This study showed the safety and efficacy of perioperative LMWH bridging therapy in elderly patients with coronary stents implanted > 12 months undergoing non-cardiac surgery. An alternative approach might be the use of bridging therapy with half-dose LMWH.

TRIAL REGISTRATION

ISRCTN65203415.

Impact of Preoperative Mental Health on Surgical Outcomes Following Robotic-assisted Radical Prostatectomy

OBJECTIVES

To explore the association between preoperative mental health status and surgical outcomes following robotic-assisted radical prostatectomy (RARP).

METHODS

This cohort study included consecutive patients undergoing RARP surgery for prostate cancer between October 2016 and May 2022 at a major public hospital in Sydney, Australia. The primary outcome was preoperative self-reported mental health status measured using the mental component score from the Short Form 36 survey. Other variables included patients' characteristics, surgical outcomes, postoperative quality of life, pain and decision regret. Data were analysed using linear regression analysis.

RESULTS

A total of 266 men underwent RARP during the studied period. Of these, 242 patients (91%) completed the preoperative survey and were analyzed. Poorer preoperative mental health had significant univariate associations with younger age (P = .025), reduced access to economic resources (P = .043), diagnosis of a mental illness (P = .033), poorer mental health at 6 weeks and 6 months postoperatively (both P <.001), greater pain (P = .001), and higher decision regret (P = .001) 6 weeks following surgery. In the multivariate analysis, poorer preoperative mental health status was associated with younger age (P = .028) and poorer mental health at 6 weeks (P <.001) and 6 months (P = .025) postoperatively.

CONCLUSION

For patients undergoing RARP, poor preoperative mental health status was associated with younger age and poorer postoperative mental health. Future studies should investigate if targeted preoperative psychological interventions would improve postoperative mental health outcomes, specifically in younger men undergoing RARP.

General anesthesia with S-ketamine improves the early recovery and cognitive function in patients undergoing modified radical mastectomy: a prospective randomized controlled trial

BACKGROUND

Postoperative cognitive dysfunction (POCD) is a common postoperative disorder that is frequently observed after general anesthesia, which seriously threatens the quality of patients' life. Existing studies have demonstrated that S-ketamine plays an important role in improving neuroinflammation. This trial aimed to explore the effects of S-ketamine on quality of recovery and cognitive function in patients following modified radical mastectomy (MRM).

METHODS

Ninety patients aged 45 to 70 years with ASA grades of I or II, who underwent MRM, were selected. Patients were randomly assigned to the S-ketamine or control group. In the S-ketamine group, patients were induced with S-ketamine instead of sufentanil and maintained with S-ketamine and remifentanil. In the control group, patients were induced with sufentanil and maintained with remifentanil. The primary outcome was the Mini-Mental State Examination (MMSE) and Quality of Recovery-15 (QoR-15) score. Secondary outcomes including visual analog scale (VAS) score, cumulative propofol and opioids consumption, post anesthesia care unit (PACU) recovery time, occurrence of remedial analgesia, postoperative nausea and vomiting (PONV), other adverse events, as well as patient satisfaction.

RESULTS

The global QoR-15 scores at postoperative day 1 (POD1) were significantly higher in the S-ketamine group than in the control group (124 [119.5-128.0] vs. 119 [114.0-123.5], P = 0.002), with a median difference of 5 points (95% confidence interval [CI] [-8 to -2]). Similarly, the global QoR-15 scores at postoperative day 2 (POD2) in the S-ketamine group were significantly higher than in the control group (140.0 [133.0-145.0] vs. 132.0 [126.5-141.5], P = 0.004). In addition, among the five subcomponents of the 15-item scale, S-ketamine group had a higher score in terms of physical comfort, pain, and emotional state both at POD1 and POD2. In terms of MMSE score, S-ketamine could promote the recovery of postoperative cognitive function at POD1, but not at POD2. Furthermore, the consumption of opioids, VAS score, and remedial analgesia in the S-ketamine group decreased significantly.

CONCLUSIONS

Collectively, our findings support that general anesthesia with S-ketamine as a potential strategy showed high safety and could not only improve the quality of recovery mainly through improving pain, physical comfort, and emotional state but also promote the recovery of cognitive function on POD1 in patients undergoing MRM.

TRIAL REGISTRATION

The study was registered in the Chinese Clinical Trial Registry (registration No:ChiCTR2200057226, Date of registration: 04/03/2022).

Effect of preoperative psychiatric morbidity on postoperative outcomes of lung cancer surgery: A nationwide cohort study in South Korea

OBJECTIVE

Lung cancer is the leading cause of cancer-related mortality worldwide, and cancer is associated with severe psychological distress. We aimed to investigate whether preoperative psychiatric morbidities affect clinical outcomes of lung cancer surgery in South Korea.

METHODS

Using the National Health Insurance Service database, all adult patients who were diagnosed with lung cancer and underwent lung cancer surgery from January 1, 2011, to December 31, 2018, were included in this retrospective, population-based cohort study. Depression, anxiety disorder, schizophrenia, alcohol abuse, non-alcohol substance abuse, and post-traumatic stress disorder were considered as preoperative psychiatric morbidities.

RESULTS

Overall, 60,031 adult patients who underwent lung cancer surgery were included in the final analysis. Of these, 17,255 (28.7%) patients had preoperative psychiatric morbidity before lung cancer surgery. Multivariable logistic regression modeling revealed patients with preoperative alcohol abuse (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.24, 5.08; P = 0.011) and those with bipolar disorder (OR: 2.91, 95% CI: 1.94, 4.53; P &lt; 0.001) to be associated with increased in-hospital mortality. Moreover, patients with preoperative psychiatric morbidities were associated with longer length of hospitalization (LOS), higher cost of hospitalization, and increased 1-year all-cause mortality.

CONCLUSION

In South Korea, patients with preoperative alcohol abuse and bipolar disorder were associated with increased in-hospital mortality after lung cancer surgery. Moreover, they were associated with increased 1-year all-cause mortality, longer LOS, and higher total costs for lung cancer surgery.

Mental health and psychosocial support for the war-wounded: A retrospective cohort study from the Democratic Republic of Congo, Mali and Nigeria

BACKGROUND

For more than 150 years, war surgery has been at the heart of the humanitarian assistance offered by the International Committee of the Red Cross (ICRC) in conflict zones around the world. Mental health and psychosocial support (MHPSS) is increasingly recognized as an integral part of the medical care offered to this highly vulnerable group of patients. This study seeks to identify patient characteristics associated with high distress prior to MHPSS and predictors of improvement following it.

METHODS

Between October 2018 and April 2020, 2,008 weapon-wounded patients received MHPSS in ICRC-supported hospitals in the Democratic Republic of Congo (DRC), Mali and Nigeria. The 21-item Depression and Anxiety Scale (DASS21), the Impact of Events Scale Revised (IES-R) and the ICRC functionality scale for Africa were administered before and after the MHPSS response. Logistic regression models were used to measure associations between outcome and exposure variables. Data was initially collected for monitoring purposes and analyzed retrospectively for the sake of this study.

RESULTS

The main reasons for surgery were firearms (65%), other weapons (13%) and mines (5%). Linear trends were found between increasing number of days between violence and first consultation and decreased likelihood of presenting high levels of anxiety (aOR 0.75, p = 0.014), and stress (aOR 0.78, p = 0.032). Violence committed by military/armed group was associated with increased likelihood of reporting high levels of anxiety (aOR 2.47, p = 0.047). On the IES-R, high scores at baseline were more likely to be found among illiterate patients (aOR 0.08, p = 0.042) and having been wounded by firearms considerably increased the likelihood of reporting high levels of PTSD (aOR 21.34, p = 0.035). Following MHPSS, 92.28% of the patients showed a reduction in symptoms on the DASS21, 93.00% showed a reduction in symptoms on the IES-R and 83.04% showed an improvement on the ICRC Africa functioning scale. On the DASS21, factors negatively associated with improved anxiety included lack of social support (aOR 0.17, p = 0.047) and suffering from a chronic medical/physical condition (aOR 0.40, p = 0.013). Patients with reduced IES-R scores were more likely to have a high level of education (aOR 8.95, p = 0.029) and to have received MHPSS that lasted between 22 and 30 days (aOR 8.73, p = 0.008). Predictors of improved functioning included being 35-44 years of age (aOR 3.74, p = 0.004) and suffering from a severe or chronic medical condition (aOR 1.66, p = 0.044).

CONCLUSIONS

Clinical implications of this study include the increased involvement of family and other caregivers in the MHPSS and longer-term follow-up of patients with severe and/or chronic medical conditions. Further research is needed with regard to joint psychological and physical outcomes, the role of the patient's education level and the personal styles and techniques used by the counsellors.

Epidemiological Relevance of Elevated Preoperative Patient Health Questionnaire-9 Scores on Clinical Improvement Following Lumbar Decompression

BACKGROUND

Limited research exists regarding the influence of preoperative depression on postoperative mental health, physical function, and pain in lumbar decompression (LD) patients. This study aims to evaluate the association of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) with other mental health and physical function clinical outcomes among patients undergoing LD.

METHODS

A prospectively maintained surgical registry was reviewed for primary LD from March 2016 to May 2019. Patients were stratified into 3 preoperative PHQ-9 score subgroups. Higher PHQ-9 scores indicated greater depressive symptoms. We assessed demographic and perioperative characteristics among subgroups with appropriate statistical testing. We also evaluated outcome instruments and postoperative improvement for the following outcomes: PHQ-9, Short Form 12 (SF-12), Veterans RAND 12-Item (VR-12), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) leg, and VAS back.

RESULTS

The 351-subject cohort was 70.4% men with an average age of 47 years; 186 subjects had minimal preoperative depressive symptoms (PHQ-9 <5), 94 had moderate (5≤ PHQ-9 ≤10), and 71 had severe (PHQ-9 >10). Subgroups with more severe symptoms of depression had worse mental health outcome scores (PHQ-9, 12-Mental Health Composite Score [12-MCS], and VR-12-MCS) and a positive linear association with greater pre- to postoperative mental health improvements at all timepoints. Subgroups with more severe symptoms of depression had worse PROMIS-PF scores at all timepoints, though VAS pain scores had no depression symptom association by 1 year.

CONCLUSION

Patients with more severe preoperative depressive symptoms, as evaluated by PHQ-9, have a greater improvement in PHQ-9, SF-12, and VR-12 scores, but more severe PHQ-9 scores are associated with worse overall physical function scores. This study demonstrates the relevance of preoperative depressive symptoms and their necessity in future risk factor models.

CLINICAL RELEVANCE

Severity of preoperative PHQ-9 acts as a significant risk factor to postoperative pain and mental and physical health improvement.

Psychological disorders confer poor functional outcomes after reverse total shoulder arthroplasty

Background

Reverse total shoulder arthroplasty (RTSA) is being used to treat a number of shoulder disorders. The purpose of the present study was to investigate the correlation between psychological disorders, drug and alcohol abuse, and postoperative complications and outcomes after RTSA.

Methods

A total of 128 patients who underwent an RTSA between January 2010 and February 2017 were identified. American Shoulder and Elbow Surgeons, SST, ROM, complications, radiographic outcomes and patient satisfaction were collected. Follow-up occurred at a minimum of 2 years postoperatively (average of 3.68 years). Statistical analysis evaluated the effects of multiple risk factors: psychological disorders, substance abuse, and preoperative diagnoses.

Results

Psychological disorder diagnosis correlated with statistically significant lower American Shoulder and Elbow Surgeons function (P = .027) and Simple Shoulder Test (P = .029) scores compared with those without a psychological disorder. It also conferred poor functional outcomes based on external rotation (P = .012). Complications, especially major complications, were more prevalent in patients with psychological diagnoses than without. A history of substance abuse correlated with a lower external rotation (P = .025).

Conclusion

Both a preoperative psychological diagnosis and a history of substance abuse conferred worse objective and functional outcomes scores after RTSA.

The effects of preoperative alcohol, tobacco, and psychological stress on postoperative complications: a prospective observational study

Background

Postoperative complications occur frequently, despite progress in anesthetic pharmacology and surgical techniques. Although habits, such as alcohol and tobacco use, and mental health have been studied individually as modifying factors, few studies have examined the relationship between multiple lifestyle choices and postoperative complications in patients undergoing surgery. Hence, this study aimed to investigate the associations between unhealthy lifestyle choices and postoperative complications.

Methods

We included 730 patients who underwent surgery in our department between March 2015 and April 2016. Participants completed preoperative questionnaires, including the Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, and tests for psychological stress (6-item Kessler Psychological Distress Scale; Hospital Anxiety and Depression Scale). Multivariable logistic analysis was used to analyze the association of preoperative drug dependence and psychological stress with postoperative complications.

Results

Of the 721 cases analyzed, 461 (64%) were women. The median age of patients was 62 years (interquartile range: 48–71). At the time of surgical decision-making, 429 out of 710 respondents (60%) had a drinking habit, and 144 out of 693 respondents (21%) had a smoking habit during the preceding year. Seventy-nine patients had developed complications. Multivariable analysis revealed that old age (p = 0.020), psychological stress (p = 0.041), and longer anesthesia time (p < 0.001) were significantly associated with postoperative complications. Drinking or smoking variables were not associated with postoperative complications.

Conclusions

Preoperative psychological stress, as evaluated with the 6-item Kessler Psychological Distress Scale, is associated with the risk of postoperative complications.

Improving Surgical Quality for Patients with Mental Health Illnesses: A Narrative Review

OBJECTIVE

To establish and define disparities in care for patients presenting with surgical disease who have pre-existing mental health diagnoses.

SUMMARY BACKGROUND DATA

Mental illness affects approximately 6.7 million Canadians. For them, stigma, comorbid disorders, and sequelae of psychiatric diagnoses can be barriers patients face to receive equitable healthcare. The goal of this review is to define inequities in surgical care for patients with pre-existing mental illness.

METHODS

We search OVID Medline, Pubmed, EMBASE, and the Cochrane review files using a combination of search terms using a PICO (population, intervention, comparison, outcome) model focusing on surgical care for patients with mental illness.

RESULTS

The literature on mental illness in surgical patients focused primarily on preoperative and postoperative disparities in surgical care between patients with and without a diagnosis of mental illness. Preoperatively, patients were 7.5-40% less likely to be deemed surgical candidates, were less likely to receive testing, and were more likely to present at later stages of their disease or have delayed surgical care. Similar themes arose in the postoperative period: patients with mental illness were more likely to require ICU admission, were up to 3 times more likely to have a prolonged length of hospital stay, had a 14-270% increased likelihood of having postoperative complications, and had significantly higher healthcare costs.

CONCLUSIONS

Surgical patients with preexisting psychiatric diagnoses have a propensity for worse perioperative outcomes compared to patients without reported mental illness. Taking a thorough psychiatric history can potentially help surgical teams address disparities and access to care as well as anticipate and prevent adverse outcomes.

Preoperative Nomogram Predicts Non-home Discharge in Patients Undergoing Pancreatoduodenectomy

BACKGROUND

In patients undergoing pancreatoduodenectomy, non-home discharge is common and often results in an unnecessary delay in hospital discharge. This study aimed to develop and validate a preoperative prediction model to identify patients with a high likelihood of non-home discharge following pancreatoduodenectomy.

METHODS

Patients undergoing pancreatoduodenectomy from 2013 to 2018 were identified using an institutional database. Patients were categorized according to discharge location (home vs. non-home). Preoperative risk factors, including social determinants of health associated with non-home discharge, were identified using Pearson's chi-squared test and then included in a multiple logistic regression model. A training cohort composed of 80% of the sampled patients was used to create the prediction model, and validation carried out using the remaining 20%. Statistical significance was defined as P < 0.05.

RESULTS

Seven hundred sixty-six pancreatoduodenectomy patients met the study criteria for inclusion in the analysis (non-home, 126; home, 640). Independent predictors of non-home discharge on multivariable analysis were age, marital status, mental health diagnosis, functional health status, dyspnea, and chronic obstructive pulmonary disease. The prediction model was then used to generate a nomogram to predict likelihood of non-home discharge. The training and validation cohorts demonstrated comparable performances with an identical area under the curve (0.81) and an accuracy of 84%.

CONCLUSION

A prediction model to reliably assess the likelihood of non-home discharge after pancreatoduodenectomy was developed and validated in the present study.

Patient-reported outcomes for ambulatory surgery

PURPOSE OF REVIEW

To discuss the importance of validated tools that measure patient-reported outcomes and their use in ambulatory surgery.

RECENT FINDINGS

Sustained increases in ambulatory surgical care reflect advances in surgical techniques and perioperative anaesthetic care. Use of patient-reported outcomes allows identification of minor adverse events that are more common in this population compared with traditional endpoints such as mortality. Variability in reported outcomes restricts research potential and limits the ability to benchmark providers. The standardized endpoints in perioperative medicine initiative's recommendations on patient-reported outcomes and patient comfort measures are relevant to evaluating ambulatory care. Combining validated generic and disease-specific patient-reported outcome measures (PROMs) examines the widest spectrum of outcomes. Technological advances can be used to facilitate outcome measurement in ambulatory surgery with digital integration optimizing accurate real-time data collection. Telephone or web-based applications for reviewing ambulatory patients were found to be acceptable in multiple international settings and should be harnessed to allow remote follow-up.

SUMMARY

Use of validated tools to measure patient-reported outcomes allows internal and external quality comparison. Tools can be combined to measure objective outcomes and patient satisfaction. These are both key factors in driving forward improvements in perioperative ambulatory surgical care.

Psychometric validation of Swedish and Arabic versions of two health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: a study protocol

INTRODUCTION

Equity in health and access to healthcare regardless of gender, ethnicity or social position is a major political issue worldwide. Regardless of an individual's knowledge, motivation and competence, individuals are expected to be engaged and take responsibility of their own care. Migrants have been identified as a vulnerable population in healthcare, and an explanation for the inequity in health and in healthcare is limited health literacy. Furthermore, with increasing digitalisation in healthcare, it also puts demand on the individual to have digital or electronic health (eHealth) literacy.The overall aim of this study is to conduct a psychometric evaluation of the Swedish and Arabic versions of HLS-EU-Q16 and eHEALS and to compare Arabic and Swedish speakers' Health literacy and eHealth literacy levels in Sweden.

METHODS AND ANALYSIS

This is a prospective, psychometric evaluation study with the intent of including 300 Arabic-speaking and 300 Swedish-speaking participants. Questionnaires: The Health Literacy Survey European Questionnaire (HLS-EU-Q16) includes 16 items measuring perceived personal skills of finding, understanding, judging and applying health information to maintain and improve their health. The eHealth literacy scale (eHEALS) is an 8-item scale measuring health literacy skills in relation to online information and applications.This study will be conducted in four phases. Phase 1: Translation of HLS-EU-Q16 and eHEALS from English to Swedish and Arabic versions following the principles of translation of questionnaires. Phase 2: Content validity testing of eHEALS, including face validity and interpretability, conducted with five Arabic and five Swedish-speaking participants. Phase 3: Psychometric testing including construct validity, reliability, feasibility and floor ceiling effects. Phase 4: Distribution and comparison of eHealth and HLS-EU-Q16 analysed with χ² and Fisher's exact test as appropriate. To assess associations between HLS-EU-Q16, eHEALS and demographic variables, binary logistic regression analyses will be performed.

ETHICS AND DISSEMINATION

The project has been approved by the regional ethical review board in Stockholm, Sweden (2019/5:1) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and social media.

Factors influencing day surgery patients' quality of postoperative recovery and satisfaction with recovery: a narrative review

The aim of healthcare services is to provide a high quality of care. One way to ensure that this aim has been fulfilled is to assess patients' satisfaction with their care. Although satisfaction is a complex concept, it is an important outcome in perioperative care. The objective of this paper is to discuss and reflect on factors that can affect patients' quality of postoperative recovery and satisfaction with recovery after day surgery. Involving patients in shared decision-making (SDM) and providing sufficient preoperative and postoperative information can improve their satisfaction. It is important to assess whether patients experience poor recovery, which can be both distressing and dissatisfying. We suggest that patients' age, sex, mental health status, and health literacy (HL) skills should be assessed preoperatively, since these factors seem to have a negative impact on patients' postoperative recovery. Identifying factors that have a negative impact on patients' quality of postoperative recovery and satisfaction with recovery after day surgery will assist healthcare professionals in supporting vulnerable patients, such as those with limited HL and poor mental health. Treating patients with respect and dignity and providing SDM can increase their quality of postoperative recovery and satisfaction with recovery.