Patient functional recovery after a 23-h surgery - a prospective, follow-up study

Abstract

Purpose: We evaluated patients' functional outcomes 2 weeks after a 23-h surgery model in a tertiary care hospital.

Methods: This prospective study comprised data on 993 consecutive adult patients who underwent a 23-h surgery. Patients were interviewed before surgery and at 14 days after surgery by telephone with a multidimensional structural survey including closed- and open-ended questions. Regarding functional outcomes, the patients were asked to assess their general wellbeing, energy levels and activities of daily living on a 5-point numeric rating scale (1 = poor to 5 = excellent). Data on patient characteristics, medical history, alcohol use, smoking status and pre-, peri- and postoperative pain and satisfaction with the care received were collected and analysed to determine whether these factors contributed to their recovery. The primary outcome measure was patient functional recovery at 14 days after surgery.

Results: Most patients reported moderate to excellent functional outcomes: 93.6% (95% CI, 92.1--95.1) of the patients showed a score ≥ 3 on the 5-point numeric scale. One out of four patients (23%) scored all three domains as excellent. A weak inverse correlation was noted between functional recovery and most pain in the 23-h postanaesthesia care unit as well as pain at 2 weeks after surgery. A weak positive correlation was noted between functional recovery and patient satisfaction with the instructions at discharge.

Conclusions: Most patients showed ample functional recovery at 14 days after the 23-h surgery. Higher pain scores in the postanaesthesia care unit and 2 weeks after surgery predicted poor functional outcomes, and satisfaction with postoperative counselling predicted better outcomes.

Trial registration: ClinicalTrials.gov NCT04142203.

Keywords: 23-H surgery; Functional recovery; Postdischarge symptoms; Postoperative recovery; Short-stay surgery.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1

Study flow chart

Fig. 2

The total number of elective surgery patients and patients operated on in the 23-h model and day surgery in different surgical specialities in Kuopio University Hospital between May 16, 2017 and May 15, 2018. ENT, ear, nose and throat

Fig. 3

Patients reported pain scores with a numerical rating scale (NRS-11, 0 = no pain, 10 = most pain) at six time points: before surgery; first pain in the 23-h post anaesthesia care unit (PACU); most pain during the 23-h PACU stay; and pain at rest, during couching, and when walking at 2 weeks after the surgery

Fig. 4

Patient satisfaction with the care on a numerical rating scale (NRS-11, 0 = totally dissatisfied, 10 = totally satisfied) at five time points: the preoperative outpatient clinic visit, preoperative planning and counselling, operative treatment, postoperative care in the 23-h post anaesthesia care unit (PACU), and counselling and instructions at discharge