Day surgery: development of a national comparative audit service

Monitoring of home recovery using the 317-nursing mobile application following day-case surgery in children: Perspectives from both nurses and patients

The number of elective day-case surgeries has considerably increased in recent years, especially in China. Few studies have investigated the ability of mobile applications to assist recovery for patients having undergone day-surgery; however, these studies have indicated that the use of mobile applications is cost-efficient and has a positive effect on recovery after surgery. This study aimed to evaluate the utility and efficacy of using the 317-nursing mobile application program (317NAPP) for monitoring home recovery following day-surgery involving high ligation of the hernial sac in pediatric patients.Prospective clinical study involving 2 parallel groups.Patients were randomly divided into the "intervention 317NAPP group" (n = 64) and the control group (n = 63). Patients were followed-up using the 317NAPP in the intervention group and via telephonic consultations in the control group. All patients were enrolled after being provided sufficient guidance with respect to discharge and health education. The health index, including the physiological function, ability to perform daily activities, and the injury response, was evaluated before and 24 hours after surgery. The time duration of each follow-up session was also evaluated in both groups.The preoperative (T1) health index scores were significantly higher than the postoperative (T0) ones in both groups (P = .00). The quality of recovery (T1-T0) of the intervention group (10.75 ± 5.28) was better than that of the control group (11.78 ± 5.16), but the differences were not significant (P = .27). In the intervention group, the follow-up time duration was significantly lower in comparison to that in the control group (P = .00).This study demonstrated that 317NAPP had a positive effect on recovery following day-surgery, and the time-duration for follow-up was shorter than that performed using telephonic consultation. Monitoring recovery using 317NAPP was safe, efficient, inexpensive, and relatively easy; therefore, it may help improve the recovery of patients having undergone day-surgery.

Prospective multicentre cohort study of patient-reported outcomes after cholecystectomy for uncomplicated symptomatic cholecystolithiasis

BACKGROUND

Up to 33 per cent of patients with uncomplicated symptomatic cholecystolithiasis report persistent pain after cholecystectomy. The aim of this study was to determine characteristics associated with patient-reported absence of abdominal pain after cholecystectomy, improved abdominal symptoms, and patient-reported positive cholecystectomy results in a prospective cohort multicentre study.

METHODS

Patients aged 18 years or more with symptomatic cholecystolithiasis who had a cholecystectomy between June 2012 and June 2014 in one of three hospitals were included. Before surgery all patients were sent the Gastrointestinal Quality of Life Index (GIQLI) questionnaire and the McGill Pain Questionnaire (MPQ). At 12 weeks after surgery, patients were invited to complete the GIQLI and Patients' Experience of Surgery Questionnaire (PESQ). Logistic regression analyses were performed to determine associations.

RESULTS

Questionnaires were sent to 552 patients and returned by 342 before and after surgery. Postoperative absence of abdominal pain was reported by 60·5 per cent of patients. A high preoperative GIQLI score, episodic pain, and duration of pain of 1 year or less were associated with postoperative absence of pain. These factors showed no association with improved abdominal symptoms (reported by 91·5 per cent of patients) or a positive surgery result (reported by 92·4 per cent).

CONCLUSION

Preoperative characteristics determine the odds for relief of abdominal pain after cholecystectomy. However, these factors were not associated with patient-reported improvement of abdominal symptoms or patient-reported positive cholecystectomy results, highlighting the variation of internal standards and expectations of patients before cholecystectomy.

Satisfaction and perceived quality of life results in patients operated on for primary hernia of the abdominal wall

INTRODUCTION

Outpatient surgery is currently the standard procedure in 60-70% of the most prevalent surgical procedures. Minimally invasive models in health care have improved basic aspects such as postoperative pain and hospital stay, but there are few publications related to perceived quality shown by patients, such as the need for informal care at home or delay before surgery. The aim of the study was to determine the global satisfaction perceived by patients undergoing abdominal wall hernia repair.

METHODS

An ad hoc split questionnaire has been completed on satisfaction after a week and postoperative quality a month after intervention by 203 patients operated on for abdominal hernia in a year. Variables included postoperative pain, need for informal care, surgical delay, information supplied, professional management and overall satisfaction.

RESULTS

A total of 48.28% of patients needed informal care at home. They were largely attended by women, wives or daughters, for a few days. In 45.81% they were discharged on the same day, and 53.2% in less than 72 h. Overall satisfaction in the program of day surgery and short hospital stay was 94.6%.

CONCLUSIONS

The overall process of satisfaction was not related to age, sex or educational level of patients, while there was an inverse relationship between satisfaction and days of hospitalization and days of pain that required analgesia at home.

Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up: a long-term prospective cohort study

BACKGROUND

Up to 41% of patients report pain after cholecystectomy and in most studies follow-up for these symptoms did not exceed 5 years. The episodic nature of abdominal pain associated with symptomatic cholelithiasis warrants long-term follow-up studies. We assessed which patient and surgical factors were associated with absence of pain and patient-reported success of surgery after ≥ 5 years of follow-up.

METHODS

Patients of ≥ 18 years of age with symptomatic cholelithiasis, classified as ASA I or II, who had previously returned a preoperative questionnaire were sent a questionnaire consisting of the gastrointestinal quality of life index (GIQLI) and patient ratings of current versus presurgical abdominal symptoms and of surgery result. Logistic regression analysis was performed to determine associations.

RESULTS

Questionnaires were sent to 197 patients and returned by 126 (64.0%) patients (73.8 % female, mean age at surgery 47.5 ± 12.2 years) at a mean of 10.0 ± 1.0 years after cholecystectomy. Absence of abdominal pain was reported by 60.3% of the patients. Patients classified as ASA II as opposed to ASA I were less likely to report absence of pain (OR 0.41, 95% CI 0.17-0.99). A positive rating of long-term postsurgical versus presurgical abdominal symptoms was given by 89.7% of the patients and 90.5% considered the cholecystectomy result to be good. No variables were significantly associated with these latter two outcome measures.

CONCLUSIONS

We found a high patient-reported surgery success rate after >5 years of follow-up after cholecystectomy despite residual abdominal pain in some of these patients. None of the patient and surgery-related characteristics were consistently associated with all three outcome measures. This discrepancy between patient' outcomes highlights the need for realistic expectations prior to cholecystectomy.

Endoscopic sinus surgery as day-case procedure

Objective:

Functional endoscopic sinus surgery is the mainstay of surgical treatment for chronic sinusitis. Day-case surgery has the advantage over in-patient surgery of being cost-effective and resource sparing. The objectives of this study were to assess our results for day-case functional endoscopic sinus surgery.

Methods:

This was a retrospective case note review of day-case functional endoscopic sinus surgery procedures performed at Leeds General Infirmary from February 2004 to February 2007. We recorded patients' demographic data, operative details, post-operative course and follow-up results.

Results:

A total of 105 day-case functional endoscopic sinus surgery procedures were included in the study. Patients' ages ranged from 16 to 93 years; 44 (41.9 per cent) were female and 61 (58.1 per cent) were male. Of these patients, 39 (37.1 per cent) had chronic sinusitis and the rest (66; 62.8 per cent) had nasal polyposis and sinusitis. Sixty-one patients (58.1 per cent) underwent surgery on the morning operating list, while the rest (44; 41.9 per cent) underwent surgery in the afternoon. Of the 105 patients, 24 (22.8 per cent) had undergone previous nasal surgery. The majority of patients (90/105; 85.7 per cent) were discharged on the same day as surgery. The only complication recorded in this study was bleeding, noted in seven patients (6.7 per cent). At the follow-up appointment, 90/105 (85.7 per cent) patients were satisfied with their post-operative results.

Conclusions:

Day-case endoscopic sinus surgery can be performed safely as a day-case procedure. The most important factors for a successful outcome are correct patient selection, in terms of general health and social circumstances, and a dedicated day-case team.

Day surgery in Scotland: patient satisfaction and outcomes

OBJECTIVE

To evaluate patients' views on the process and outcome of day surgery in Scotland, and to study patients' satisfaction with care in a range of specific procedures.

DESIGN

Questionnaires completed by a census of day case surgery patients within a band of 25 procedures under the umbrella of five broad groups: (1) general surgery; (2) urology; (3) gynaecology; (4) orthopaedics; (5) ear, nose, and throat; ophthalmology.

SETTING

13 hospitals in six health board areas in Scotland.

SUBJECTS

During the period 1995-6, 5069 day case patients were asked to complete a questionnaire within two weeks of their operation and discharge from hospital.

MAIN OUTCOME MEASURES

Arrangements before admission; immediate postoperative symptoms and complications; problems experienced after discharge; readmission after discharge.

RESULTS

A response rate of 68% was obtained from 13 sites ranging from 43% to 82%. The overall satisfaction score was 85. A total of 894 patients (26%) experienced pain after surgery and 783 (23%) had relatively minor medical problems after discharge. In total, 265 (7.8%) patients were readmitted to hospital after discharge. Few notable differences existed between specialties or hospitals in terms of satisfaction scores, although notable pain was experienced more frequently in gynaecology and general surgery patients. Readmission was more common for urological procedures.

CONCLUSION

Overall, patient satisfaction with day case surgery was high. Dissatisfaction was largely related to waiting times between admission, operation, and discharge. The amount of pain experienced also had a notable impact on the level of patient satisfaction. Day surgery is not without complications, with 26% of patients experiencing notable degrees of pain; 23% having minor medical problems after discharge; and 8% of respondents having to reattend hospital with problems relating to their original operations.