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BMC Surgery
Published in: BMC Surgery 1/2017

Open Access 01-12-2017 | Research article

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

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

Published in: BMC Surgery | Issue 1/2017

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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).
Appendix
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Literature
1.
Dohan FC, Taylor EW Jr, Moss NH. The role of the surgeon in the prolongation of uncomplicated surgical convalescence. Surg Gynecol Obstet. 1960;111:49–57.PubMed
2.
Williams MA. Easier convalescence from hysterectomy. Am J Nurs. 1976;76(3):438–40.PubMed
3.
Carter E. Ready for home?... Preparing for convalescence after a hysterectomy. Nur Times. 1981;77:826–9.
4.
Brown A. Pre-operative teaching--a literature review. Br J Theatr Nurs. 1992;2(3):S15–S6.
5.
Devine EC. Effects of psychoeducational care for adult surgical patients: a meta-analysis of 191 studies. Patient Educ Couns. 1992;19(2):129–42.CrossRefPubMed
6.
Easton K, Read MD, Woodman NM. Influence of early discharge after hysterectomy on patient outcome and GP workloads. J Obstet Gynaecol. 2003;23(3):271–5.CrossRefPubMed
7.
Kruzik N. Benefits of preoperative education for adult elective surgery patients. AORN J. 2009;90(3):381–7.CrossRefPubMed
8.
9.
Mitchell M. Home recovery following day surgery: a patient perspective. J Clin Nurs. 2015;24(3–4):415–27.CrossRefPubMed
10.
Auer CJ, Glombiewski JA, Doering BK, Winkler A, Laferton JA, Broadbent E, et al. Patients' expectations predict surgery outcomes: a meta-analysis. Int J Behav Med. 2016;23(1):49–62.CrossRefPubMed
11.
Moller C, Ottesen M, Kehlet H, Ottesen BS. Convalescence recommendations after hysterectomy. A study of opinions among Danish physicians. Ugeskr Laeger. 2001;163(50):7043–7.PubMed
12.
Kalkur S, McKenna D, Dobbs SP. ‘Doctor--when can I drive?’--advice obstetricians and gynaecologists give on driving after obstetric or gynaecological surgery. Ulster Med J. 2007;76(3):141–3.PubMedPubMedCentral
13.
Gilmartin J. Contemporary day surgery: patients' experience of discharge and recovery. J Clin Nurs. 2007;16(6):1109–17.CrossRefPubMed
14.
Bradshaw C, Beard C, Pritchett CJ, Wilson A, Armitage TG, Wynn K. How quickly do patients recover from operations: the postoperative recovery study (P.O.R.S). J one-day Surgery. 2008;18(2):48–51.
15.
Bradshaw C, Pritchett C, Bryce C, Coleman S, Nattress H. Information needs of general day surgery patients. Ambul Surg. 1999;7(1):39–44.CrossRef
16.
Ottesen M, Moller C, Kehlet H, Ottesen B. Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair. A nationwide questionnaire study. Acta Obstet Gynecol Scand. 2001;80(11):1062–8.PubMed
17.
Kikuchi I, Takeuchi H, Shimanuki H, Kitade M, Kumakiri J, Kuroda K, et al. Questionnaire analysis of recovery of activities of daily living after laparoscopic surgery. J Minim Invasive Gynecol. 2008;15(1):16–9.CrossRefPubMed
18.
19.
Murphy M, Olivera C, Wheeler T, Casiano E, Siddiqui N, Gala R, et al. Postoperative management and restrictions for female pelvic surgery: a systematic review. Int Urogynecol J. 2013;24(2):185–93.CrossRefPubMed
20.
Tran TT, Kaneva P, Mayo NE, Fried GM, Feldman LS. Short-stay surgery: what really happens after discharge? Surgery. 2014;156(1):20–7.CrossRefPubMed
21.
22.
Jarrett ME. Pre-operative advice given by general practitioners and consultants to patients concerning return to work. Ann R Coll Surg Engl. 1998;80(4 Suppl):171–3.PubMed
23.
Minig L, Trimble EL, Sarsotti C, Sebastiani MM, Spong CY. Building the evidence base for postoperative and postpartum advice. Obstet Gynecol. 2009;114(4):892–900.CrossRefPubMed
24.
Naidu M, Sultan AH, Thakar R. Convalescence advice following gynaecological surgery. J Obstet Gynaecol. 2012;32(6):556–9.CrossRefPubMed
25.
Graff BM, Thomas JS, Hollingsworth AO, Cohen SM, Rubin MM. Development of a postoperative self-assessment form. Clin Nurse Spec. 1992;6(1):47–50.CrossRefPubMed
26.
Fortner PA. Preoperative patient preparation: psychological and educational aspects. Semin Perioper Nurs. 1998;7(1):3–9.PubMed
27.
Horvath KJ. Postoperative recovery at home after ambulatory gynecologic laparoscopic surgery. J Perianesth Nurs. 2003;18(5):324–34.CrossRefPubMed
28.
Mistiaen P, Francke AL, Poot E. Interventions aimed at reducing problems in adult patients discharged from hospital to home: a systematic meta-review. BMC Health Serv Res. 2007;7:47.CrossRefPubMedPubMedCentral
29.
Waller A, Forshaw K, Carey M, Robinson S, Kerridge R, Proietto A, et al. Optimizing patient preparation and surgical experience using eHealth technology. JMIR Med Inform. 2015;3(3):e29.CrossRefPubMedPubMedCentral
30.
Vonk Noordegraaf A, Huirne JAF, Brolmann HAM, Van Mechelen W, Anema JR. Multidisciplinary convalescence recommendations after gynaecological surgery: a modified Delphi method among experts. BJOG. 2011;118(13):1557–67.CrossRefPubMed
31.
Pittens CA, Vonk Noordegraaf A, van Veen SC, Anema JR, Huirne JA, Broerse JE. The involvement of gynaecological patients in the development of a clinical guideline for resumption of (work) activities in the Netherlands. Health Expect. 2015;18(5):1397–412.CrossRefPubMed
32.
Bouwsma EVA, Vonk Noordegraaf A, Szlavik Z, Brolmann HAM, Emanuel MH, Lips JP, et al. Process evaluation of a multidisciplinary care program for patients undergoing gynaecological surgery. J Occup Rehabil. 2014;24(3):425–38.PubMed
33.
Vonk Noordegraaf A, Anema JR, van Mechelen W, Knol DL, van Baal WM, van Kesteren PJ, et al. A personalised eHealth programme reduces the duration until return to work after gynaecological surgery: results of a multicentre randomised trial. BJOG. 2014;121(9):1127–35. discussion 36CrossRefPubMed
34.
Bouwsma EVA, Huirne JAF, van de Ven PM, Vonk Noordegraaf A, Schaafsma FG, Schraffordt Koops SE, et al. Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation. BMJ Open. 2017;
35.
Bouwsma EVA, Bosmans JE, van Dongen JM, Brolmann HAM, Anema JR, Huirne JAF. Cost-effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecologic patients: economic evaluation alongside a stepped-wedge cluster-randomised trial. BMJ Open. 2017;
36.
Vonk Noordegraaf A, Huirne JAF, Brolmann HAM, Emanuel MH, van Kesteren PJM, Kleiverda G, et al. Effectiveness of a multidisciplinary care program on recovery and return to work of patients after gynaecological surgery; design of a randomized controlled trial. BMC Health Serv Res. 2012;12:29.CrossRefPubMedPubMedCentral
37.
Bouwsma EVA, Anema JR, Vonk Noordegraaf A, Knol DL, Bosmans JE, Schraffordt Koops SE, et al. The cost effectiveness of a tailored, web-based care program to enhance postoperative recovery in gynecologic patients in comparison with usual care: protocol of a stepped wedge cluster randomized controlled trial. JMIR Res Protoc. 2014;3(2):e30.CrossRefPubMedPubMedCentral
38.
Clayton M, Verow P. Advice given to patients about return to work and driving following surgery. Occup Med (Lond). 2007;57(7):488–91.CrossRef
39.
Shand AW, Harpham ME, Lainchbury A, McCormack L, Leung S, Nassar N. Knowledge, advice and attitudes toward women driving a car after caesarean section or hysterectomy: a survey of obstetrician/gynaecologists and midwives. Aust N Z J Obstet Gynaecol. 2016;56(5):460–5.CrossRefPubMed
40.
Callesen T, Klarskov B, Bech K, Kehlet H. Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work. Eur J Surg. 1999;165(3):236–41.CrossRefPubMed
41.
Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Factors determining convalescence after uncomplicated laparoscopic cholecystectomy. Arch Surg. 2001;136(8):917–21.CrossRefPubMed
42.
Clayton M, Verow PA. Retrospective study of return to work following surgery. Occup Med (Lond). 2007;57(7):525–31.CrossRef
43.
Bay-Nielsen M, Bisgaard T. Convalescence and sick leave following inguinal hernia repair. Ugeskr Laeger. 2009;171(40):2899–901.PubMed
44.
Bergman S, Feldman LS, Barkun JS. Evaluating surgical outcomes. Surg Clin North Am. 2006;86(1):129–49.CrossRefPubMed
45.
Ebrahim S, Malachowski C, Kamal El DM, Mulla SM, Montoya L, Bance S, et al. Measures of patients' expectations about recovery: a systematic review. J Occup Rehabil. 2015;25(1):240–55.CrossRefPubMed
46.
Macedonia CR, Johnson CT, Rajapakse I. Advanced research and data methods in Women's health: big data analytics, adaptive studies, and the road ahead. Obstet Gynecol. 2017;
47.
Cook DJ, Thompson JE, Prinsen SK, Dearani JA, Deschamps C. Functional recovery in the elderly after major surgery: assessment of mobility recovery using wireless technology. Ann Thorac Surg. 2013;96(3):1057–61.CrossRefPubMed
48.
Appelboom G, Camacho E, Abraham ME, Bruce SS, Dumont EL, Zacharia BE, et al. Smart wearable body sensors for patient self-assessment and monitoring. Arch Public Health. 2014;72(1):28.CrossRefPubMedPubMedCentral
49.
Appelboom G, Yang AH, Christophe BR, Bruce EM, Slomian J, Bruyere O, et al. The promise of wearable activity sensors to define patient recovery. J Clin Neurosci. 2014;21(7):1089–93.CrossRefPubMed
50.
van der Meij E, van der Ploeg HP, van den Heuvel B, Dwars BJ, Meijerink W, Bonjer HJ, et al. Assessing pre- and postoperative activity levels with an accelerometer: a proof of concept study. BMC Surg. 2017;17(1):56.CrossRefPubMedPubMedCentral
Metadata
Title
Using patient data to optimize an expert-based guideline on convalescence recommendations after gynecological surgery: a prospective cohort study
Authors
Esther V. A. Bouwsma
Johannes R. Anema
A. Vonk Noordegraaf
Henrica C. W. de Vet
Judith A. F. Huirne
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2017
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-017-0317-8

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