Recovery after shoulder arthroscopy: Inpatient versus outpatient management

A quantitative, multicentre, longitudinal study of patient experiences after gynaecological day surgery

AIM

The aim of this study was to explore patients' experiences after gynaecological day surgery one and 30 days postoperatively, as well as potential factors influencing these experiences.

DESIGN

The study had a multicentre, quantitative, longitudinal design.

METHODS

The study was conducted in three different hospitals' day surgical unit and included patients undergoing gynaecological surgery in general anaesthesia. We used a questionnaire including the European Quality of Life tool (EQ5D3L), the Quality-of-Recovery-15 questionnaire (QoR-15) and items relating to patient experiences, the first day (T1, n = 444) and 30 days (T2, n = 193) after surgery. Data were collected in the period March 2019 to March 2020.

RESULTS

Results show that patients mainly had positive experiences and ranged quality of recovery high, even though some areas needed improvement. Patient scores on the QoR-15 relating to their experiences 24 h postoperative were rated higher at T1 than at T2. Twenty per cent of the respondents experienced complications such as infection, haemorrhage and pain. About 1/5 of these contacted healthcare services, and three per cent was hospitalized. EQ5D score was the only factor that made an statistically significant impact on patients' experiences with quality of recovery (R² .169, F = 82.87). However, this effect was weak.

Age-related differences in cognition and postoperative quality of recovery after beach chair position shoulder surgery

We examined the influence of age in beach chair position shoulder surgery and postoperative quality of recovery by conducting a single-site, observational, cohort study comparing younger aged (18-40 years) versus older aged (at least 60 years) patients admitted for elective shoulder surgery in the beach chair position. Endpoints were dichotomous return of function to each patient's individual preoperative baseline as assessed using the postoperative quality of recovery scale; measuring cognition, nociception, physiological, emotional, functional activities and overall perspective. We recruited 112 (41 younger and 71 older aged) patients. There was no statistical difference in cognitive recovery at day three postoperatively (primary outcome): 26/32 younger patients (81%) versus 43/60 (72%) older patients, P=0.45. Rates of recovery were age-dependent on domain and time frame (secondary outcomes), with older patients recovering faster in the nociceptive domain (P=0.02), slower in the emotional domain (P=0.02) and not different in the physiological, functional activities and overall perspective domains (all P >0.35). In conclusion, we did not show any statistically significant difference in cognitive outcomes between younger and older patients using our perioperative anaesthesia and analgesia management protocol. Irrespective of age, 70% of patients recovered by three months in all domains.

Multimodal oral analgesia strategy after ambulatory arthroscopic shoulder surgery: case series using adaptive therapeutic approaches by sequential analysis

BACKGROUND

Pain control and quality of recovery (QoR) at home remains a challenge after ambulatory shoulder arthroscopy. This study aims to assess the QoR and pain relief using a sequential implementation strategy for rescue analgesic drugs.

METHODS

After institutional review board approval, patients (>18 years, American Society of Anesthesiology [ASA] score 1-3 stable) scheduled for ambulatory surgery under general anesthesia with a single-shot interscalene nerve block were enrolled. After discharge, patients received standard information regarding the postoperative recovery and care consisting of a multimodal analgesic regime (acetaminophen and ketoprofen for 5 days). The first 48 postoperative hours allowed us to compare 3 different rescue drug regimes with a control group, in sequential order: tramadol (control group), tramadol + nefopam, immediate-release oxycodone (IR), and extended-release oxycodone (ER). The primary endpoint was the QoR 40 score at 48 hours after surgery. Secondary endpoints were pain relief and adverse events over a 7-day period. An intention-to-treat statistical analysis was performed with sequential analysis (as an interim analysis) every 20 patients. Results were recorded as medians and interquartiles (25-75).

RESULTS

We analyzed 109 patients with similar characteristics among groups. The QoR 40 scores were similar for the tramadol group (168 [161-172]), the tramadol + nefopam group (161 [151-173], P = .09), and the IR group (164 [153-169], P = .17), but higher for the ER group (176 [167-181], P = .03). Concerning adverse events, drugs were interrupted more frequently in the tramadol + nefopam group (36 %). In the ER group, a higher quality of postoperative relief was attained in the domains of pain and sleep.

CONCLUSION

The present study shows that a combination of IR and ER oxycodone over a short period of time (<48 hours) is associated with a better QoR at home after ambulatory shoulder surgery.

Impact of Local Infiltration Analgesia on the Quality of Recovery After Anterior Total Hip Arthroplasty: A Randomized, Triple-Blind, Placebo-Controlled Trial

BACKGROUND

Local infiltration analgesia (LIA) is commonly used in anterior total hip arthroplasty (THA) surgery; however, evidence for its efficacy is lacking. We hypothesized that LIA with 0.2% ropivacaine when compared with injection of placebo (0.9% saline) would improve patient quality of recovery on postoperative day (POD) 1, as measured by the Quality of Recovery-15 (QoR-15) score.

METHODS

Patients scheduled to have a primary unilateral anterior THA with a single surgeon in a tertiary level metropolitan hospital were randomized to receive LIA with either 2.5 mL/kg of 0.2% ropivacaine or 0.9% saline as placebo. Patients and clinical and study personnel were blinded to group allocation. Perioperative care was standardized and this included spinal anesthesia and oral multimodal analgesia. The primary outcome was a multidimensional (pain, physical comfort, physical independence, emotions, and psychological support) patient-reported quality of recovery scale, QoR-15, measured on POD 1.

RESULTS

One hundred sixty patients were randomized; 6 patients were withdrawn after randomization and 2 patients had incomplete outcome data. The intention-to-treat analysis included 152 patients. The median (interquartile range [IQR]) QoR-15 score on POD 1 of the ropivacaine group was 119.5 (102-124), compared with the placebo group which had a median (IQR) of 115 (98-126). The median difference of 2 (95% confidence interval [CI], -4 to 7; P = .56) was not statistically or clinically significant. An as-per-protocol sensitivity analysis of 146 patients who received spinal anesthesia without general anesthesia, and the allocated intervention, also showed no evidence of a significant difference between groups. Secondary outcomes (worst pain numerical rating scale at rest and with movement on POD 1, opioid consumption on PODs 1 and 2, mobilization on POD 1, Brief Pain Inventory severity and interference on POD 90, and length of stay) were similar in both groups.

CONCLUSIONS

LIA with 0.2% ropivacaine when compared with 0.9% saline as placebo did not improve quality of recovery 1 day after anterior THA.