Using patient data to optimize an expert-based guideline on convalescence recommendations after gynecological surgery: a prospective cohort study

Esther V A Bouwsma, Johannes R Anema, A Vonk Noordegraaf, Henrica C W de Vet, Judith A F Huirne, Esther V A Bouwsma, Johannes R Anema, A Vonk Noordegraaf, Henrica C W de Vet, Judith A F Huirne

Abstract

Background: Convalescence advice is often based on tradition and anecdote from health care providers, rather than being based on experiences from patients themselves. The aim of this study was to analyse recovery in terms of resumption of various daily activities including work, following different laparoscopic and abdominal surgery in order to optimize an expert-based guideline on convalescence recommendations.

Methods: This is a prospective cohort study conducted in nine general and one university hospital in the Netherlands. Women aged 18-65 years and scheduled for a hysterectomy (laparoscopic, vaginal, abdominal) and/or laparoscopic adnexal surgery (n = 304) were eligible to participate. Preoperatively, participants were provided with tailored expert-based convalescence recommendations on the graded resumption of several daily activities including sitting, standing, walking, climbing stairs, bending, lifting, driving, cycling, household chores, sport activities and return to work (RTW). Postoperatively, time until the resumption of these activities was tracked. Convalescence recommendations were considered correct when at least 25% and less than 50% of the women were able to resume an activity before or at the recommended recovery time.

Results: There was a wide variation in the duration until the resumption of daily activities within and between groups of patients undergoing different types of surgery. Recovery times lengthened with increasing levels of physical burden as well as with increasing levels of invasiveness of the surgery. For the majority of activities actual recovery times exceeded the recovery time recommended by the expert panel.

Conclusions: This study provided insight in the resumption of daily activities after gynecological surgery and the adequacy of an expert-based convalescence guideline in clinical practice. Patient data was used to optimize the convalescence recommendations.

Trial registration: Dutch trial registry, NTR2087 (August 2009) and NTR2933 (June 2011).

Keywords: Convalescence advice; eHealth; hysterectomy; laparoscopic adnexal surgery; return to normal activities; return to work.

Conflict of interest statement

Ethics approval and consent to participate

Both trials were approved by the VUmc Medical Ethical Committee (9 February 2009, no. 2009/42 and 16 May 2011, no. 2011/142). Informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. EB, AV, HV have no conflicts of interest or financial ties to disclose. JH and JA intend to set up a spin-off company concerning the implementation of a mobile application concerning the “ikherstel” intervention in the Netherlands. The other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Example of a tailored convalescence plan generated at the patient web portal. In the left column activities are listed that were selected by the patient. The pink boxes present the amount of time the patient is recommended to avoid the specific activity. The blue boxes present the duration after surgery (and the specific date) after which the patient is recommended to resume the specific activity
Fig. 2
Fig. 2
Differences between actual and recommended recovery times after laparoscopic hysterectomy. The vertical red line presents the convalescence guideline. The boxplots present the 25th percentile, median (thick vertical line) and 75th percentile of the differences between actual recovery times and the recommended recovery times. White boxes present activities that were being performed by more than 50% of the patients before or at the recommended recovery time. Green boxes present activities that were being performed by 25% to 50% of the patients faster than the recommended recovery times. Red boxed present activities that were being performed by less than 25% of the patients faster than the recommended recovery times.a guidelines were not revised due to algorithm taking other surgical types into account (lifting 5 kg, cycling). N, number of patients that provided data on the activity; IQR, interquartile range
Fig. 3
Fig. 3
Actual and recommended recovery times for the activity walking per type of surgery. The boxplots present the 25th percentile, median (thick vertical line) and 75th percentile of the actual recovery times. The diamonds represent the recommended recovery times. LAS, laparoscopic adnexal surgery; LH, laparoscopic hysterectomy; VH, vaginal hysterectomy; AH, abdominal hysterectomy
Fig. 4
Fig. 4
Kaplan-Meier survival curves for time to full sustainable RTW, presented per type of surgery. Number of days represent days of sick leave after surgery until RTW

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