Postoperative recovery from the perspective of day surgery patients: A phenomenographic study

Abstract

Background

Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patients’ own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home.

Objective

To explore day surgery patients’ different perceptions of postoperative recovery.

Design

A qualitative design with a phenomenographic approach was used.

Methods and settings

Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face to face at the patients’ homes, 11–37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital.

Results

The patients perceived postoperative recovery as comprising internal and external prerequisites and implying changes in ordinary life with varying levels of support. The effective production at the day surgery unit was perceived as having an impact on patients’ prerequisites for recovery. The results are elucidated in three descriptive categories: ‘Conditions for recovery at home’, ‘The rollback to ordinary life’ and ‘Being a cog in a flow of care’.

Conclusions

The postoperative phase seems to be a weak link in day surgery care. From the patients’ perspective, postoperative recovery following day surgery implies extensive responsibility at home. Patients need knowledge and understanding concerning what constitutes the normal range in recovery and how to manage self-care following their specific surgical procedure.

Introduction

Day surgery is widely applied in many countries’ health care systems and often represents more than 50% of all surgery (Toftgaard, 2009). This study has been carried out in Sweden, where approximately 80% of elective surgery is performed as a day surgical procedure (Toftgaard, 2012). Several surgeries have been transferred from in-hospital to day surgical procedures (e.g. laparoscopic cholecystectomy, anterior cruciate ligament repair, hernia repair in the elderly, shoulder surgery as well as minor procedures for gynaecological prolapse and urine incontinency) (Segerdahl et al., 2007). Day surgery implies admittance, surgery and discharge without an overnight stay (Toftgaard and Parmentier, 2006), and minimal disruption of ordinary life (Mottram, 2010). Most patients appreciate the possible choice of day surgery (Lemos et al., 2009, Martin et al., 2010, Rhodes et al., 2006), and it is perceived as less risky (risks concerning anaesthesia, loss of personal autonomy and separation from one's family) than if undergoing an in-hospital surgical procedure (Mottram, 2012). On the other hand, the day surgery patient does not have the advantage of postoperative surveillance by professionals following discharge (Kleinbeck, 2000). Instead, postoperative care is transferred to the patient and the family, who have to manage the recovery by themselves, which might raise feelings of insecurity at home (Boughton and Halliday, 2009, Mitchell, 2003, Mottram, 2011a). A lack of professional support (Mottram, 2011b), information and insufficient preparation for self-care at home (Boughton and Halliday, 2009), inadequate communication between day surgery and community care (Mitchell, 2003) and overoptimistic expectations concerning recovery (Gilmartin, 2007, Mottram, 2010) may contribute to this insecurity. However, from a personal and social perspective the transfer of responsibility for postoperative care to the home environment is mostly accepted by patients and their families (Majholm et al., 2012).

The postoperative course is influenced by many factors, including patient characteristics, type of surgery and anaesthesia, and social factors (Bettelli, 2009). Postoperative symptoms can be troublesome, and are a common reason for unplanned contact with health care following discharge (Mattila et al., 2005). Symptoms also cause a delay in patients’ return to daily life functions (Rosén et al., 2009). Reviews report pain and nausea as the most common postoperative symptoms, followed by drowsiness, tiredness, fatigue and dizziness (Rosén et al., 2009, Schnaider and Chung, 2006, Wu et al., 2002). Patients also have to deal with psychological issues post-discharge, for instance mood swings and anxiety. Also, a changed body image and appearance due to swelling and discoloration of the surgery site might be bothersome for some patients (Demir et al., 2008, Gilmartin, 2007). Many day surgery patients expect recovery to be fast (Mottram, 2010), with no (or only limited) effects on role functions. However, non-resumed role functions in family and social life are not unusual (Horvath, 2003, Mottram, 2010, Mottram, 2011a). Nursing in day surgery has to adapt to an environment characterized by productivity and cost-effectiveness. To ensure a safe and efficient throughput, nursing often focuses on physiological measurements. However, to attain a patient-centred approach and to enable patients to successfully manage their recovery, psychosocial aspects have to be taken into account (Demir et al., 2008, Mitchell, 2010).

Day surgery has developed very rapidly in recent decades, and is today a ‘streamlined’ process offering excellent physical care. Yet, when it comes to the time following surgery, research indicates a lack of support for patients’ management of their postoperative recovery at home (Mottram, 2011b). To improve the care, a better understanding of variations in patients’ needs after surgery would be valuable. The aim of this study was therefore to explore day surgery patients’ different experiences of postoperative recovery.