Assessment of recovery after day surgery using a modified version of quality of recovery-40
Available from: Mark Mitchell
- "McIntosh and Adams  employed the Quality of Recovery instrument (QoR-40)  and Hospital Anxiety and Depression Scale . Berg et al  used the validated Swedish Post-discharge Recovery Scale  and Quality of Recovery-29 Scale  modified scales of the original by Kleinbeck  and Myles et al  per se. Rosén et al (72, 73) utilised the Swedish version of the Brief Pain Inventory (BPI-SF) . "
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ABSTRACT: Aim: To evaluate the experiences of patients and caregivers in the early transition phase of recovery at home following day surgery.
Background: A global increase in elective day surgery has taken place over the last two decades. This has arisen from enhanced surgical and anaesthetic techniques, healthcare cost containment and patient preference. Minimal hospital stay ensures meticulously managed medical practices are uppermost leaving nursing-based knowledge limited room for expression. However, patients may require much help once discharged hence providing nurse-led involvement in this area with much potential.
Data Sources: Five databases from 2000 – 2011 were searched including MEDLINE, CINAHL, British Nursing Index, PsychINFO and Cochrane Database of Systematic Reviews. Reference and citation tracking was performed on included publications.
Review Methods: One reviewer screened titles and abstracts for possible inclusion over a 10 month period. Data synthesis involved thematic analysis informed by the findings of the included literature.
Twenty-five studies were included in the review. Common themes were pain, information provision and anxiety. Pain management was a concern exacerbated by reduced information. Much information had been forgotten due to latent effects of anaesthesia, limited opportunity on the day of surgery or information booklets lacking a problem-solving approach. Anxiety was associated with inadequate information, unexpected events or by carers striving to supervise a successful recovery.
Recovery at home with limited access to healthcare professionals presented a number of challenges mostly relating to inadequate knowledge/ information. Future research should explore continued nurse/ patient contact, nurse-led support services and patient and carer information booklet content.
Available from: link.springer.com
- "Patient-reported outcome measures comprise an essential part in the assessment of quality of surgical care and are recommended for benchmarking . Quality of recovery in the early postoperative period has been assessed in several studies [9-12]. However, patient assessed recovery after the first postoperative week has been less frequently studied , and only few studies have evaluated health-related quality of life during the period, when patients are returning back to work and other daily routines [14-16]. "
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Increasing numbers of elective surgical procedures are performed as day-cases. The impact of ambulatory surgery on health-related quality of life in the recovery period has seldom been described.
We assessed health-related quality of life in 143 adult outpatients scheduled for arthroscopic procedures of the knee and shoulder joints, laparoscopic cholecystectomy and inguinal hernia repair using the RAND 36-Item Health Survey preoperatively and one week after patients had returned to work or comparable normal daily routines.
Postoperatively all patient groups reported significant improvements in bodily pain and vitality. Physical functioning improved significantly in orthopedic and inguinal hernia patients. However, in the orthopedic groups, postoperative scores for physical health were still relatively lower compared to the general population reference values.
Ambulatory surgery has a positive impact on health-related quality of life. Assessment of the recovery process is necessary for recognition of potential areas of improvement in care and postoperative rehabilitation.
Available from: Kristofer Arestedt
- "The QoR-23 is a self-rating instrument with 23 items rated on a five-point scale (1–5) . The items are summed with a maximum total score of 115, and higher scores indicate higher quality of recovery. "
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Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge.
A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.
Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).
Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.
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