Effect of nurse-led telephone follow-up on postoperative symptoms and analgesics consumption after benign hysterectomy: a randomized, single-blinded, four-arm, controlled multicenter trial

Abstract

Purpose: The study aimed to determine if planned telephone follow-up, especially when adding structured, oriented coaching, reduces the intensity of postoperative symptoms and decreases analgesics consumption after benign hysterectomy.

Methods: A randomized, single-blinded, four-armed, controlled multicenter trial of 525 women scheduled for hysterectomy was conducted in 5 hospitals in the southeast health region of Sweden. The women were allocated 1:1:1:1 into four follow-up models: (A) no telephone follow-up (control group); (B) one planned, structured, telephone follow-up the day after discharge; (C) as B but with additional telephone follow-up once weekly for 6 weeks; and (D) as C but with oriented coaching telephone follow-up on all occasions. Postoperative symptoms were assessed using the Swedish Postoperative Symptoms Questionnaire. Analgesic consumption was registered. Unplanned telephone contacts and visits were registered during the 6 weeks of follow-up.

Results: In total, 487 women completed the study. Neither pain intensity, nor symptom sum score or analgesic consumption differed between the intervention groups. Altogether, 224 (46.0%) women had unplanned telephone contacts and 203 (41.7%) had unplanned visits. Independent of intervention, the women with unplanned telephone contacts had higher pain intensity and symptom sum scores, particularly if an unplanned telephone contact was followed by a visit, or an unplanned visit was preceded by an unplanned telephone contact.

Conclusion: Telephone follow-up did not seem to affect recovery regarding symptoms or analgesic consumption after benign hysterectomy in an enhanced recovery after surgery (ERAS) setting. Unplanned telephone contacts and visits were associated with more postoperative symptoms, especially pain. Trial registration The study is registered in ClinicalTrial.gov: NCT01526668 retrospectively from January 27; 2012. Date of enrolment of first patient: October 11; 2011.

Keywords: Coaching; ERAS; Hysterectomy; Postoperative symptoms; Telephone follow-up.

Conflict of interest statement

The authors of the manuscript “Effect of nurse-led telephone follow-up on postoperative symptoms and analgesics consumption after benign hysterectomy: a randomized, single-blinded, four-arm, controlled multicenter trial” have no relevant financial or non-financial or competing interests to disclose.

© 2022. The Author(s).

Figures

Fig. 1

CONSORT flowchart of participants in the POSTHYSTREC trial

Fig. 2

Maximum pain intensity and average pain intensity after benign hysterectomy from day 2 to day 42 postoperatively in relation to invention group. Pain intensity measured on a scale from 0 (no pain) to 6 (very severe pain). Results of repeated measures ANOVA are shown in the table below the diagrams

Fig. 3

Symptom sum score postoperatively after benign hysterectomy in relation to intervention group. Symptom sum score ranges from 8 to 32. The higher the sum score the more symptoms. Results of repeated measures ANOVA are shown in the table below the diagram

Fig. 4

Consumption of opioids (in equivalent intravenous morphine (mg)) and non-opioids (in defined daily dose according to WHO [13]) after benign hysterectomy in relation to intervention group. Results of repeated measures ANOVA are shown in the table below the diagrams

Fig. 5

Post hoc tests of the significant outcomes depicted in Table 3 between groups, (A) with and without unplanned telephone contacts, and (B) with and without unplanned visits. Plots indicate means and bars represent 95% confidence interval