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Burden Incurred by Patients and Their Caregivers After Outpatient Surgery: A Prospective Observational Study

  • Symposium: Perioperative Pain Management in Orthopaedic Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Introduction

The burden of patients and their caregivers after outpatient surgery has not been fully examined. The number of outpatient surgeries has dramatically increased in the last several years, particularly in the orthopaedic sector. Patients undergoing outpatient orthopaedic procedures may be expected to have more postdischarge pain than those undergoing nonorthopaedic outpatient procedures. In light of this, assessment of patient and caregiver expectations and actual burden after discharge is of importance.

Questions/purposes

We assessed the impact of outpatient surgery on recovery of patients and their caregivers in the postoperative period by determining (1) expected versus actual time to resume daily activities, including work; (2) expected versus actual recovery at 7 and 30 days postoperatively; and (3) the number of caregivers that felt emotional or physical disturbances from caring for outpatients.

Methods

Forty-four adult patients undergoing outpatient surgical procedures and their primary caregivers were enrolled in this prospective survey study, of which 30% were orthopaedic patients. Surveys assessing postoperative recovery were given to patients at six time points, on Postoperative Days 0 to 3, 7, and 30. Surveys assessing the burden of informal caregiving were given to each patient’s primary caregiver at four time points, on Postoperative Days 1 to 3 and 7. The enrollment rate was 79% (44 enrolled of 56 approached) and the survey response rate was 100% for patients and 93% (41 of 44) for caregivers.

Results

We found that 16 of 44 patients (36%) needed more time than originally anticipated to resume their daily activities and three of 29 patients (10%) needed more time off from work than originally anticipated. Patients were approximately 66% and 88% fully recovered 7 and 30 days after surgery, respectively. The primary caregivers noted disturbances in emotional (nine of 43, 21%) and physical (17 of 43, 40%) aspects of their daily lives while providing care for patients. Our surveyed patients were from multiple surgical services; however, our results may be generalized to an orthopaedic population, although they may underestimate actual results for this population given their generally higher pain scores.

Conclusions

Patients may take longer to recover from outpatient surgery than previously recognized. As increased pain and prolonged recovery may be associated with increased caregiver burden, these data are of particular significance to the outpatient orthopaedic surgical population. Informal caregiving after outpatient surgery may be an unrecognized physical and psychologic burden and may have a significant societal impact.

Level of Evidence

Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

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References

  1. Aslan O, Kav S, Meral C, Tekin F, Yesil H, Ozturk U, Bulut Z, Anaboifo A, Dover M, Yazar B. Needs of lay caregivers of bone marrow transplant patients in Turkey: a multicenter study. Cancer Nurs. 2006;29:E1–E7.

    Article  PubMed  CAS  Google Scholar 

  2. Brattwall M, Stomberg MW, Rawal N, Segerdahl M, Houltz E, Jakobsson J. Patient assessed health profile: a size-month quality of life questionnaire survey after day surgery. Scand J Public Health. 2010;38:574–579.

    Article  PubMed  CAS  Google Scholar 

  3. Bruce DG, Paley GA, Nichols P, Roberts D, Underwood PJ, Schaper F. Physical disability contributes to caregiver stress in dementia caregivers. J Gerontol A Biol Sci Med Sci. 2005;60:345–349.

    Article  PubMed  Google Scholar 

  4. Cannuscio CC, Colditz GA, Rimm EB, Berkman LF, Jones CP, Kawachi I. Employment status, social ties, and caregivers’ mental health. Soc Sci Med. 2004;58:1247–1256.

    Article  PubMed  Google Scholar 

  5. Cousins R, Davies AD, Turnbull CJ, Playfer JR. Assessing caregiving distress: a conceptual analysis and a brief scale. Br J Clin Psychol. 2002;41:387–403.

    Article  PubMed  Google Scholar 

  6. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009;11:1–25.

    PubMed  Google Scholar 

  7. Detmer DE. Ambulatory surgery: a more cost-effective treatment strategy? Arch Surg. 1994;129:123–127.

    Article  PubMed  CAS  Google Scholar 

  8. From I, Nordström G, Wilde-Larsson B, Johansson I. Caregivers in older peoples’ care: perception of quality of care, working conditions, competence and personal health. Scand J Caring Sci. 2013;27:704–714.

    Article  PubMed  Google Scholar 

  9. Gupta A, Wu CL, Elkassabany N, Krug CE, Parker SD, Fleisher LA. Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery? A systematic review of randomized controlled trials. Anesthesiology. 2003;99:488–495.

    Article  PubMed  Google Scholar 

  10. Hall MJ, Lawrence L. Ambulatory surgery in the United States, 1996. Adv Data. 1998;300:1–16.

    PubMed  Google Scholar 

  11. Ilfeld BM, Enneking FK. A portable mechanical pump providing over four days of patient-controlled analgesia by perineural infusion at home. Reg Anesth Pain Med. 2002;27:100–104.

    Article  PubMed  Google Scholar 

  12. Ivarsson AB, Sidenvall B, Carlsson M. The factor structure of the Burden Assessment Scale and the perceived burden of caregivers for individuals with severe mental disorders. Scand J Caring Sci. 2004;18:396–401.

    Article  PubMed  Google Scholar 

  13. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89:652–658.

    PubMed  CAS  Google Scholar 

  14. Matilla K, Lahtela M, Hynynen M. Health-related quality of life following ambulatory surgery procedures: assessment by RAND-36. BMC Anesthesiol. 2012;12:30.

    Article  Google Scholar 

  15. McGarth B, Elgendy H, Chung F, Kamming D, Curti B, King S. Thirty percent of patients have a moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients. Can J Anesth. 2004;51:886–891.

    Article  Google Scholar 

  16. McMurray A, Johnson P, Wallis M, Patterson E, Griffiths S. General surgical patients’ perspectives of the adequacy and appropriateness of discharge planning to facilitate health decision-making at home. J Clin Nurs. 2007;16:1602–1609.

    Article  PubMed  Google Scholar 

  17. Rawal N. Postdischarge complications and rehabilitation after ambulatory surgery. Curr Opin Anaesthesiol. 2008;21:736–42.

    Article  PubMed  Google Scholar 

  18. Rawal N, Hylander J, Nydahl P, Olofsson I, Gupta A. Survey of postoperative analgesia following ambulatory surgery. Acta Anesthesiol Scand. 1997;41:1017–1022.

    Article  CAS  Google Scholar 

  19. Sales E. Family burden and quality of life. Qual Life Res. 2003;12(suppl 1):33–41.

    Article  PubMed  Google Scholar 

  20. Swan BA, Maislin G, Traber KB. Symptom distress and functional states changes during the first seven days after ambulatory surgery. Anesth Analg. 1998;86:739–745.

    PubMed  CAS  Google Scholar 

  21. Swenson JD, Cheng GS, Axelrod DA, Davis JJ. Ambulatory anesthesia and regional catheters: when and how. Anesthesiol Clin. 2010;28:267–280.

    Article  PubMed  Google Scholar 

  22. US Census Bureau. American Community Survey, 2005–2009. Mapping America: Every City, Every Block. Available at: http://projects.nytimes.com/census/2010/explorer. Accessed January 2, 2013.

  23. US Department of Labor. The Family and Medical Leave Act of 1993. Available at: http://www.dol.gov/compliance/guide/fmla.htm. Accessed January 2, 2013.

  24. US Department of Labor. Vacation leave. Available at: http://www.dol.gov/dol/topic/workhours/vacation_leave.htm. Accessed January 2, 2013.

  25. van Exel NJ, Brouwer WB, van den Berg B, Koopmanschap MA, van den Bos GA. What really matters: an inquiry into the relative importance of dimensions of informal caregiver burden. Clin Rehabil. 2004;18:683–693.

    Article  PubMed  Google Scholar 

  26. Viñoles J, Ibáñez MV, Ayala G. Predicting recovery at home after ambulatory surgery. BMC Health Serv Res. 2011;11:269.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Wilson LS, Moskowitz JT, Acree M, Heyman MB, Harmatz P, Ferrando SJ, Folkman S. The economic burden of home care for children with HIV and other chronic illnesses. Am J Public Health. 2005;95:1445–1452.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Witters D, Agrawal S. Unhealthy U.S. workers’ absenteeism costs $153 billion. October 17, 2011 Gallup Wellbeing. Available at: http://www.gallup.com/poll/150026/unhealthy-workers-absenteeism-costs-153-billion.aspx. Accessed July 24, 2013.

  29. Wolff JL. Family matters in health care delivery. JAMA. 2012;308:1529–1530.

    Article  PubMed  CAS  Google Scholar 

  30. Wu CL, Berenholtz SM, Pronovost PJ, Fleisher LA. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology. 2002;96:994–1003.

    Article  PubMed  Google Scholar 

  31. Yabroff KR, Kim Y. Time costs associated with informal caregiving for cancer survivors. Cancer. 2009;115(18 suppl):4362–4373.

    Article  PubMed  Google Scholar 

  32. Younis J, Salerno G, Chaudhary A, Trickett JP, Bearn PE, Scott HJ, Galbraith KA. Reduction in hospital reattendance due to improved preoperative patient education following hemorrhoidectomy. J Healthc Qual. 2012 May 3 [Epub ahead of print].

  33. Yun YH, Rhee YS, Kang IO, Lee JS, Bang SM, Lee WS, Kim JS, Kim SY, Shin SW, Hong YS. Economic burdens and quality of life of family caregivers of cancer patients. Oncology. 2005;68:107–114.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Mohammad Naqibuddin MPH for his assistance in data collection.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD, 21287, USA

    Asha Manohar MD, Kristin Cheung MD, Christopher L. Wu MD & Tracey S. Stierer MD

Authors
  1. Asha Manohar MD
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  2. Kristin Cheung MD
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  3. Christopher L. Wu MD
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  4. Tracey S. Stierer MD
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Corresponding author

Correspondence to Christopher L. Wu MD.

Additional information

One or more of the authors (CLW) certifies that he or she received, during the study period, funding from the Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA. Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Manohar, A., Cheung, K., Wu, C.L. et al. Burden Incurred by Patients and Their Caregivers After Outpatient Surgery: A Prospective Observational Study. Clin Orthop Relat Res 472, 1416–1426 (2014). https://doi.org/10.1007/s11999-013-3270-6

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  • DOI: https://doi.org/10.1007/s11999-013-3270-6

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