Implementation of 23 Hour Surgery Model in a Tertiary Hospital (Herko)

23 Hour Surgical Model in a Tertiary Hospital: Evaluation From Patient and Organisational Perspective

Extended day surgery or 23 h surgery (23-hour surgery) is a surgical model where patients arrive to the hospital from home at the day of surgery, are operated and recover in a 23 h surgery unit. 23H surgery units are usually situated near postoperative recovery unit. THe 23 H surgical model was implemented in Kuopio University Hospital 2015 and between May 2017-May 2018 patients were recruited in the present prospective follow up cohort study. Patients were informed and they gave their informed consent. The patients were contacted two weeks after the study and details of their recovery were asked.

Study Overview

• Status: Completed
• Conditions: Ovarian Cysts; Shoulder Impingement Syndrome; Appendicitis; Cholecystolithiasis; Laparoscopy; Ambulatory Surgical Procedures; Neurosurgery; Ambulatory Surgery; Gynecologic Surgical Procedures
• Intervention / Treatment: Other: 23 h surgery

Detailed Description

Extended day surgery or 23 h surgery is a surgical model where patients arrive to the hospital from home at the day of surgery, are operated and recover in a 23 h surgery unit. 23H surgery units are usually situated near postoperative recovery unit. THe 23 H surgical model was implemented in Kuopio University Hospital 2015 and between May 2017-May 2018 patients were recruited in the present prospective follow up cohort study. Patients were informed and they gave their informed consent. The patients were contacted two weeks after the study and details of their recovery were asked. Satisfaction to the care in 23 h unit and surgical process, were asked. Amount of readmissions, reoperations, contacts to health care professionals and adverse events are recorded.

Detailed information about intensity of pain, analgesic need and use in the hospital was recorded and pain interference in daily life for short term recovery period was asked.

• Study Type: Observational
• Enrollment (Actual): 993

Contacts and Locations

Study Locations

• Finland
  • Northern Savo
    • Kuopio, Northern Savo, Finland, 70029
      • Kuopio University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adults undergoing 23 h surgery

Description

Inclusion Criteria:

• adult
• gave informed consent

Exclusion Criteria:

• no informed consent

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
23 h surgery; Adult patients who were treated in 23 h surgical unit	Other: 23 h surgery; Patients were treated in 23 surgical unit

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Amount of patients discharged from the hospital until 10 am at the first postoperative day	The amount of patients discharged from hospital by the first postoperative day 10 am	Postoperative day 1
Pain intensity postoperatively	Pain intensity after surgery for the first 24 hours	Postoperative day 1
Analgesic consumption postoperatively	Amount of different analgesics consumed during the 24 h period postoperatively	Postoperative day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
30 days readmission rate	How many patients are admitted to hospital within 30 postoperative days	one month after surgery
30 days reoperation rate	How many patients are reoperated within 30 postoperative days	one month after surgery
Number of adverse events during 14 postoperative days	Amount of adverse events after surgery within 14 postoperative days	14 days after surgery
Contact to health care during 14 postoperative days	Number of contacts to health care within 14 postoperative days	14 days afte surgery
Patient satisfaction to care in 23 hours process	Scale 0-7 (0= not satisfied, 7 =very satisfied), the higher score the better result	14 days after surgery
Proportion of patients having pain postoperatively	Amount of patients who had pain still two weeks after surgery	Two weeks postoperatively
Postoperative pain interference after 23 h surgery	Patient assessed pain interference in daily activities up to 2 weeks after surgery	two weeks postoperatively
Analgesic use after 23 h surgery	amount of patients using analgesics two weeks after surgery	Two weeks postoperatively

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adverse events after 23 h surgery	Adverse events after 23 h surgical procedure	two weeks after surgery

Collaborators and Investigators

• Sponsor: Kuopio University Hospital
• Investigators: Principal Investigator: Ulla-Maija Ruohoaho, MD, Kuopio University Hospital

Publications and helpful links

General Publications

• Isokaanta S, Ruohoaho UM, Anttila M, Kokki H, Sintonen H, Toroi P, Kokki M. Resilience, pain, and health-related quality of life in gynecological patients undergoing surgery for benign and malignant conditions: a 12-month follow-up study. BMC Womens Health. 2022 Aug 16;22(1):345. doi: 10.1186/s12905-022-01923-7.
• Ruohoaho UM, Aaltomaa S, Kokki H, Anttila M, Kokki M. Patient functional recovery after a 23-h surgery - a prospective, follow-up study. Langenbecks Arch Surg. 2022 Aug;407(5):2133-2142. doi: 10.1007/s00423-022-02502-y. Epub 2022 Apr 6.
• Ruohoaho UM, Toroi P, Hirvonen J, Aaltomaa S, Kokki H, Kokki M. Implementation of a 23-h surgery model in a tertiary care hospital: a safe and feasible model with high patient satisfaction. BJS Open. 2020 Jun;4(3):391-399. doi: 10.1002/bjs5.50267. Epub 2020 Feb 28.

Study record dates

Study Major Dates

• Study Start (Actual): May 16, 2017
• Primary Completion (Actual): May 30, 2021
• Study Completion (Actual): May 30, 2021

Study Registration Dates

• First Submitted: October 17, 2019
• First Submitted That Met QC Criteria: October 25, 2019
• First Posted (Actual): October 29, 2019

Study Record Updates

• Last Update Posted (Actual): April 12, 2022
• Last Update Submitted That Met QC Criteria: April 5, 2022
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Keywords: analgesic; outcome; postoperative pain; patient satisfaction; oxycodone; postoperative recovery; 23 h surgery; multimodal pain management; extended day surgery
• Additional Relevant MeSH Terms: Digestive System Diseases; Infections; Neoplasms; Wounds and Injuries; Endocrine System Diseases; Cysts; Ovarian Diseases; Adnexal Diseases; Gonadal Disorders; Gastrointestinal Diseases; Joint Diseases; Musculoskeletal Diseases; Gastroenteritis; Shoulder Injuries; Intestinal Diseases; Pathological Conditions, Anatomical; Gallbladder Diseases; Biliary Tract Diseases; Cecal Diseases; Intraabdominal Infections; Calculi; Shoulder Impingement Syndrome; Appendicitis; Gallstones; Cholelithiasis; Cholecystolithiasis; Ovarian Cysts
• Other Study ID Numbers: KUH507A030

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No