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Eerdekens GJ, Van Beersel D, Rex S, Gewillig M, Schrijvers A, Al Tmimi L. The patient with congenital heart disease in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:421-436. [PMID: 37938087 DOI: 10.1016/j.bpa.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
The number of patients with congenital heart disease (CHD) undergoing ambulatory surgery is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists' Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator. Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.
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Affiliation(s)
- Gert-Jan Eerdekens
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Dieter Van Beersel
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - An Schrijvers
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Layth Al Tmimi
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium.
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Park R, Mohiuddin M, Arellano R, Pogatzki-Zahn E, Klar G, Gilron I. Prevalence of Postoperative Pain Following Hospital Discharge: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e22437. [PMID: 33275105 PMCID: PMC7748962 DOI: 10.2196/22437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/21/2020] [Accepted: 11/10/2020] [Indexed: 01/22/2023] Open
Abstract
Background Pain is one of the most common, feared, and unpleasant symptoms associated with surgery. However, there is a clear gap in patient care after surgical patients are discharged from hospital, resulting in poorly controlled postoperative pain. Inadequate pain management after discharge can have detrimental effects on quality of life and lead to the development of chronic postsurgical pain. The severity of postoperative pain before discharge is well described, but less emphasis has been placed on assessing pain at home after hospital discharge. Objective The objective of this review is to summarize the prevalence of moderate-to-severe postoperative pain within the first 1 to 14 days after hospital discharge. Methods A detailed search of epidemiological studies investigating postoperative pain will be conducted on MEDLINE and EMBASE from their inception until the date the searches are run. The primary outcome will be the proportion of patients reporting moderate-to-severe postoperative pain at rest and with movement within the first 1 to 14 days after hospital discharge. The secondary outcomes will include a comparison of postoperative pain after discharge between patients who underwent ambulatory and inpatient surgery, and adverse outcomes attributable to poor pain control after hospital discharge (eg, readmission to hospital, emergency room or other unplanned medical visits, or a decrease in quality of life). Results The protocol has been registered in PROSPERO (registration number CRD42020194346). The search strategies for MEDLINE and EMBASE have been completed. The final results are expected to be published in May 2021. Conclusions This systematic review is expected to synthesize evidence describing the prevalence of postoperative pain after hospital discharge. Available epidemiological evidence may help inform the magnitude of the problem of postoperative pain at home after hospital discharge. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020194346; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=194346 International Registered Report Identifier (IRRID) PRR1-10.2196/22437
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Affiliation(s)
- Rex Park
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Mohammed Mohiuddin
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Gregory Klar
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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Mitchell M. Home recovery following day surgery: a patient perspective. J Clin Nurs 2014; 24:415-27. [DOI: 10.1111/jocn.12615] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Mark Mitchell
- Faculty of Health and Social Care; University of Salford; Salford UK
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Dionigi G, Bacuzzi A, Rovera F, Boni L, Piantanida E, Tanda ML, Castano P, Annoni M, Bartalena L, Dionigi R. Shortening hospital stay for thyroid surgery. Expert Rev Med Devices 2014; 5:85-96. [DOI: 10.1586/17434440.5.1.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nelson CP, Rosoklija I, Grant R, Retik AB. Development and implementation of a photographic atlas for parental instruction and guidance after outpatient penile surgery. J Pediatr Urol 2012; 8:521-6. [PMID: 22018934 DOI: 10.1016/j.jpurol.2011.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 09/27/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop and evaluate a visual tool to assist parents in assessing healing after surgical circumcision or revision circumcision (SCRC). METHODS Among children undergoing SCRC, photographs were taken on postoperative days 0-1-2-3-5-7-10-14-21, and compiled into an atlas. Atlas utility was assessed during two 1-month periods. During the first period (M1) families received routine postoperative instructions only; during the second period (M2), families received the atlas in addition to routine instructions. Families were surveyed by phone and calls/contacts were tracked. RESULTS 33 families (among 83 SCRCs) were surveyed during M1, vs 39 families (among 77 SCRCs) during M2 (p = 0.17). Nearly all reported the atlas helpful (59% very helpful, 27% moderately helpful, 9% somewhat helpful). All but one family used the atlas. There was a trend toward families receiving the atlas being more comfortable (64% vs 82% very comfortable, p = 0.12). Survey scores were similar between M1 and M2 for total score, satisfaction, and the number whose expectations were met (58% vs 55%, p = 0.21). Phone contacts decreased between M1 and M2, both in absolute number (M1 = 24 calls vs M2 = 12 calls), and as a proportion of total cases performed (29% vs 16%, p = 0.04). CONCLUSIONS The circumcision atlas was well received by families and was associated with a significant decrease in post-surgical telephone calls. The atlas has been put into routine clinical use with excellent response.
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Affiliation(s)
- Caleb P Nelson
- Department of Urology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
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Majholm B, Esbensen BA, Thomsen T, Engbaek J, Møller AM. Partners’ experiences of the postdischarge period after day surgery - a qualitative study. J Clin Nurs 2012; 21:2518-27. [DOI: 10.1111/j.1365-2702.2012.04116.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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MAJHOLM B, ENGBAEK J, BARTHOLDY J, OERDING H, AHLBURG P, ULRIK AMG, BILL L, LANGFRITS CS, MØLLER AM. Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures. Acta Anaesthesiol Scand 2012; 56:323-31. [PMID: 22335277 DOI: 10.1111/j.1399-6576.2011.02631.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort. METHODS We prospectively recorded data from 57,709 day surgery procedures performed in eight day surgery centres over a 3-year period. We cross-checked with the National Patient Registry to identify complications 0-30 days post-operatively, and registrations from The Danish Register of Cause of Death were requested. We retrieved the records of 1174 patients to assign a relation between secondary contact and day surgery. RESULTS The overall rate of return hospital visits was 1.21% [95% confidence interval (CI): 1.12-1.30%] caused by a wide range of diagnoses. No deaths were definitely related to day surgery. The return hospital visits were due to haemorrhage/haematoma 0.50% (95% CI: 0.44-0.56%), infection 0.44% (95% CI: 0.38-0 49%) and thromboembolic events 0.03%. Major morbidity was rare. The surgical procedures with the highest rate of complication were tonsillectomies 11.4%, surgically induced abortions 3.13% and inguinal hernia repairs 1.23%. CONCLUSION This large-scale Danish national study confirmed that day surgery is associated with a very low rate of return hospital visits. Despite the rapid expansion of day surgery, safety has been maintained, major morbidity being very rare, and no deaths being definitely related to day surgery.
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Affiliation(s)
- B. MAJHOLM
- Department of Anaesthesiology and Intensive Care Medicine; Copenhagen University Hospital; Herlev; Denmark
| | - J. ENGBAEK
- Department of Anaesthesiology and Intensive Care Medicine; Copenhagen University Hospital; Herlev; Denmark
| | - J. BARTHOLDY
- Department of Anaesthesiology and Intensive Care Medicine; Copenhagen University Hospital; Herlev; Denmark
| | - H. OERDING
- Department of Anaesthesiology; Vejle Hospital; Vejle; Denmark
| | - P. AHLBURG
- Department of Anaesthesiology Day Surgery Unit; Aarhus University Hospital; Aarhus; Denmark
| | - A.-M. G. ULRIK
- Department of Anaesthesiology; Hospital of Southern Jutland; Aabenraa; Denmark
| | - L. BILL
- Department of Anaesthesiology; Regional Hospital; Herning; Denmark
| | - C. S. LANGFRITS
- Department of Anaesthesiology; Regional Hospital; Horsens; Denmark
| | - A. M. MØLLER
- Department of Anaesthesiology and Intensive Care Medicine; Copenhagen University Hospital; Herlev; Denmark
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Lo S, Stuenkel DL, Rodriguez L. The Impact of Diagnosis-Specific Discharge Instructions on Patient Satisfaction. J Perianesth Nurs 2009; 24:156-62. [DOI: 10.1016/j.jopan.2009.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 02/11/2009] [Accepted: 03/08/2009] [Indexed: 11/29/2022]
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Dionigi G, Rovera F, Carrafiello G, Boni L, Dionigi R. Ambulatory thyroid surgery: Need for stricter patient selection criteria. Int J Surg 2008; 6 Suppl 1:S19-21. [DOI: 10.1016/j.ijsu.2008.12.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIM To determine patients' problems with day case cystoscopy and their problem solving ways and patients' self-care at home. BACKGROUND Day surgery has become increasingly common in the last 20 years. Cystoscopic procedures are increasingly being carried out as a diagnostic and therapeutic procedures. DESIGN AND METHOD This descriptive/prospective study comprised 50 patients undergoing day case cystoscopic procedures in the university hospital of Turkey. The data were collected using telephone interview three days after the procedure. The two questionnaire used were Symptom Measurement Questionnaire and Symptom Management Questionnaire. Discharge information and written instruction was given to all patients. RESULTS It was found in the investigation that the most common problems experienced by the patients were tiredness, haematuria, dysuria, pain over bladder and difficulty in voiding after flexible cystoscopy in first day. Generally, urinary elimination problems were experienced by majority of the patients. At second day, these problems were also common. The mean score for all problems decreased after three days. The patients stated that they were able to deal with their symptoms either independently or to a lesser extent with assistance of a carer. But they were unable to deal with problems such as especially haematuria. CONCLUSION Problems experiences by the patients at home after cystoscopy influenced some daily living activities. The problems related to voiding are more frequently observed after cystoscopy. Although some these problems are related to the procedures, some were present previously. RELEVANCE TO CLINICAL PRACTICE This findings indicate that patient-centred care should be strengthened at home in urological day surgery.
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Affiliation(s)
- S Erkal
- Ankara University, Cebeci School of Health, Ankara, Turkey.
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Erkal S. Patients’ experiences at home after day case cystoscopy. J Clin Nurs 2007. [DOI: 10.1111/j.1365-2702.2005.01500.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Joshi GP, Ogunnaike BO. Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain. ACTA ACUST UNITED AC 2005; 23:21-36. [PMID: 15763409 DOI: 10.1016/j.atc.2004.11.013] [Citation(s) in RCA: 308] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Inadequately controlled pain has undesirable physiologic and psychologic consequences such as increased postoperative morbidity, delayed recovery, a delayed return to normal daily living, and reduced patient satisfaction. Importantly, the lack of adequate postoperative pain treatment may lead to persistent pain after surgery, which is often overlooked. Overall, inadequate pain management increases the use of health care resources and health care costs. This article reviews the physiologic and psychologic consequences of inadequately treated pain, with an emphasis on chronic persistent postoperative pain.
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Affiliation(s)
- Girish P Joshi
- Perioperative Medicine and Ambulatory Anesthesia, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USA.
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Watt-Watson J, Chung F, Chan VWS, McGillion M. Pain management following discharge after ambulatory same-day surgery. J Nurs Manag 2004; 12:153-61. [PMID: 15089952 DOI: 10.1111/j.1365-2834.2004.00470.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM AND BACKGROUND Same-day surgeries are becoming routine for many surgical procedures. However, the degree to which patients need help with pain management at home following laparoscopic cholecystectomy (LC), shoulder, or hand ambulatory day surgery has received minimal examination. This study examined pain and related interference, analgesic use and adverse events, complications and resources utilized, and adequacy of postdischarge information at four time periods. METHODS Data were collected from 180 patients by telephone interviews at 24, 48 and 72 hours, and 7 days after discharge. Patients (n = 78 hand, 48 shoulder, 54 LC surgery) were on average 41 years old. RESULTS For all patients, worst 24-hour pain was reported as moderate to severe at all time periods. Using repeated measures anova demonstrated that shoulder patients had significantly more pain and overall pain-related interference, particularly in sleep and work, from 24 hours to day 7 than did hand or LC patients. The main analgesic taken was acetaminophen (paracetamol) with codeine 30 mg; 50% took no analgesia from 72 hours. About 20% experienced analgesic adverse events within 72 hours, mainly constipation and nausea. Only </=6% used non-pharmacological strategies. Bleeding (4%) and sore throat (11%) at 24-48 hours were identified as complications; six patients (4%) called their physician. Most patients received no information about analgesic use with inadequate pain relief and/or adverse events. CONCLUSIONS Despite the considerable pain reported across all time periods, analgesic use and other interventions were minimal. Adverse events, which were problematic for some, may explain why patients stopped analgesics despite pain. These data support further research on more effective pain interventions and related education for day-surgery patients after discharge.
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Affiliation(s)
- Judy Watt-Watson
- Faculty of Nursing, and Centre for the Study of Pain, University of Toronto, Ontario, Canada.
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