Patterns of Changes in Patients' Postoperative Recovery From a Short-Term Perspective

Feeling Safe in the Perioperative Period: Experiences from Patients Undergoing Orthopedic Day Surgery

Introduction

Day surgery is often preferred by patients, but it can pose challenges in self-management after discharge. In addition, patients undergoing orthopedic surgery report poorer rates of postoperative recovery than patients undergoing general surgery. Understanding patients' perceptions of feeling safe while undergoing surgery facilitates individualized care and is important since it may affect their recovery.

Objective

The aim of this study was to describe patients' perceptions of feeling safe in the perioperative period when undergoing orthopedic day surgery under regional anesthesia.

Methods

The design was qualitative and descriptive. Data were collected through a cross-sectional questionnaire containing open-ended questions. Qualitative content analysis with an inductive approach was used for data analysis. Participants' characteristics were presented descriptively. The study population consisted of a consecutive sample of 97 patients who had undergone orthopedic day surgery under regional anesthesia between March and October 2022.

Results

The categorization process resulted in the development of two categories describing participants' experience of perioperative feelings of safety when undergoing orthopedic day surgery: having someone near and having a sense of control. The results indicate that the relationship between patients and staff and the perceived feeling of control and participation are factors influencing patients' perception of feeling safe in the perioperative period.

Conclusions

In perioperative care, nurses play a vital role in fostering patients' sense of safety by establishing relationships. This ensures that patients can be actively engaged in their own care. Patients also need access to professional and competent staff who strives to add a personal touch and considers their perspective. Since patients undergoing orthopedic day surgery might face a more demanding postoperative recovery than they had initially anticipated, further research is suggested to explore the association between a perceived feeling of safety and postoperative recovery.

Psychometric Evaluation of the Postoperative Recovery Profile

Aim

To further evaluate the postoperative recovery profile regarding its psychometric properties.

Background

The postoperative recovery profile is an instrument for the self-assessment of general postoperative recovery that has received increased attention within nursing research. However, psychometric evaluation during development was sparse.

Design

Psychometric evaluation was done using classical test theory.

Method

Data quality, targeting, reliability, and scaling assumptions were measured. In addition, confirmatory factor analysis was used to evaluate construct validity. Data collection was made during 2011-2013.

Result

Data derived from this study showed acceptable quality; however, item distribution was skewed, with ceiling effects in the majority of items. Cronbach's alpha showed high internal consistency. Item-total correlations indicated unidimensionality, whereas six items demonstrated high correlations pointing at redundancy. The confirmatory factor analysis confirmed problems related to dimensionality as the five proposed dimensions were highly correlated with each other. Furthermore, items were largely uncorrelated with the designated dimensions.

Conclusion

This study shows that the postoperative recovery profile needs to be further developed to serve as a robust instrument within nursing as well as medical research. Arguably, values from the instrument should not be calculated at a dimensional level for the time being because of discriminant validity issues.

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.

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

PURPOSE

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

DESIGN

A mixed methods design.

METHODS

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

FINDINGS

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

CONCLUSIONS

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

Patients' Perceptions of Short-Term Recovery After a Gastric Bypass

PURPOSE

To explore gastric bypass patients' perceptions of their postoperative recovery over 1 month.

DESIGN

A standardized questionnaire, the postoperative recovery profile, was used.

METHODS

Postoperative recovery profile is a multi-item questionnaire for self-assessment of general postoperative recovery. Participants were patients who had undergone gastric bypass surgery (n = 39). The changes in recovery between 1 day and 1 month postsurgery were evaluated by a statistical method developed specifically for analyzing changes in paired ordered data over time.

FINDINGS

Most of the symptoms and/or functions were significantly improved on a group level. The most marked improvement was to pain and sleeping difficulties followed by mobilization. In terms of the psychological items, the proportion of patients who indicated no problems was high at both endpoints. The items that deviated from the improvement pattern were appetite changes and gastrointestinal function which demonstrated a relatively high proportion of deterioration, and the individual variability was prominent.

CONCLUSIONS

There is a need for interventions to improve recovery on a group as well as an individual level.