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Jaensson, M., Dahlberg, K. & Nilsson, U. (2019). Factors influencing day surgery patients’ quality of postoperative recovery and satisfaction with recovery: A narrative review. Perioperative Medicine, 8, Article ID 3.
Open this publication in new window or tab >>Factors influencing day surgery patients’ quality of postoperative recovery and satisfaction with recovery: A narrative review
2019 (English)In: Perioperative Medicine, ISSN 0908-6919, E-ISSN 2047-0525, Vol. 8, article id 3Article, review/survey (Refereed) Published
Abstract [en]

The aim of healthcare services is to provide a high quality of care. One way to ensure that this aim has been fulfilled is to assess patients’ satisfaction with their care. Although satisfaction is a complex concept, it is an important outcome in perioperative care. The objective of this paper is to discuss and reflect on factors that can affect patients’ quality of postoperative recovery and satisfaction with recovery after day surgery. Involving patients in shared decision-making (SDM) and providing sufficient preoperative and postoperative information can improve their satisfaction. It is important to assess whether patients experience poor recovery, which can be both distressing and dissatisfying. We suggest that patients’ age, sex, mental health status, and health literacy (HL) skills should be assessed preoperatively, since these factors seem to have a negative impact on patients’ postoperative recovery. Identifying factors that have a negative impact on patients’ quality of postoperative recovery and satisfaction with recovery after day surgery will assist healthcare professionals in supporting vulnerable patients, such as those with limited HL and poor mental health. Treating patients with respect and dignity and providing SDM can increase their quality of postoperative recovery and satisfaction with recovery.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Ambulatory surgical procedures, Postoperative period, Preoperative period, Patient satisfaction, Quality of healthcare
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Surgery
Identifiers
urn:nbn:se:oru:diva-74137 (URN)10.1186/s13741-019-0115-1 (DOI)000470006900001 ()31139359 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013–4765Swedish Research Council, 2015–02273
Available from: 2019-05-09 Created: 2019-05-09 Last updated: 2019-06-20Bibliographically approved
Dahlberg, K., Jaensson, M. & Nilsson, U. (2019). “Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: secondary analysis of a randomized controlled trial. International Journal of Surgery, 33-37
Open this publication in new window or tab >>“Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: secondary analysis of a randomized controlled trial
2019 (English)In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, p. 33-37Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients undergoing day surgery are expected to manage their recovery on their own. Follow-up routines differ, but many patients have expressed a need for more professional support during recovery. The aim of this study was to describe how many follow-up contacts were initiated, and when and why, via a digital solution. Also, we wanted to compare postoperative recovery and characteristics between patients requesting, and patients not requesting, contact.

MATERIALS AND METHODS: This was a secondary analysis of a multicenter, two-group, parallel randomized controlled trial. Participants used a digital solution called "Recovery Assessment by Phone Points (RAPP)" for initiating follow-up contacts after day surgery. The quality of postoperative recovery was measured with the Swedish web-version of Quality of Recovery.

RESULTS: Of 494 patients, 84 (17%) initiated contact via RAPP. The most common reasons for initiating contact were related to the surgical wound and pain. Contacts were initiated across the 14-day assessment period, with 62% (62/100) in the first postoperative week. The RAPP contact group had significantly poorer postoperative recovery on days 1-14 compared to those not requesting contact via RAPP (p < 0.001). There was a significantly higher proportion of patients who had undergone general anesthesia in the RAPP contact group (85% [71/84]) compared to the non-RAPP contact group (71% [291/410]), p = 0.003.

CONCLUSION: Letting the patient decide him/herself whether, and when, contact and support is needed during the postoperative period, is possible and does not increase the frequency of contacts. This study investigates a digital solution, RAPP, as one example of a person-centered approach that can be implemented in day surgery follow-up.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Ambulatory surgery, Follow-up, eHealth
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Surgery
Identifiers
urn:nbn:se:oru:diva-70268 (URN)10.1016/j.ijsu.2018.11.022 (DOI)000455016300005 ()30503602 (PubMedID)2-s2.0-85057781234 (Scopus ID)
Funder
Swedish Research Council, 2015-02273Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765
Available from: 2018-11-22 Created: 2018-11-22 Last updated: 2019-03-26Bibliographically approved
Nilsson, U., Dahlberg, K. & Jaensson, M. (2019). Low Preoperative Mental and Physical Health is Associated with Poorer Postoperative Recovery in Patients Undergoing Day Surgery: A Secondary Analysis from a Randomized Controlled Study. World Journal of Surgery, 43(8), 1949-1956
Open this publication in new window or tab >>Low Preoperative Mental and Physical Health is Associated with Poorer Postoperative Recovery in Patients Undergoing Day Surgery: A Secondary Analysis from a Randomized Controlled Study
2019 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 8, p. 1949-1956Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Day surgical procedures are increasing both in Sweden and internationally. Day surgery patients prepare for and handle their recovery on their own at home. The aim of this study was to investigate patients' preoperative mental and physical health and its association with the quality of their recovery after day surgery.

METHOD: This was a secondary analysis of a randomized controlled trial. Data were collected at four-day surgery units in Sweden. Health-related quality of life was measured using the Short Form 36 (SF-36) Health Survey, and postoperative recovery was assessed using the Swedish web version of the Quality of Recovery (SwQoR) scale.

RESULT: This study included 756-day surgery patients. A low, compared with a high, preoperative mental component score was associated with poorer recovery as shown by responses to 21/24 and 22/24 SwQoR items, respectively, on postoperative days (PODs) 7 and 14. A low compared with a high preoperative physical component score was associated with poorer recovery in 18/24 SwQoR items on POD 7 and 13/24 on POD 14.

CONCLUSION: A clear message from this study is for surgeons, anaesthetists and nurses to consider the fact that postoperative recovery largely depends on patients' preoperative mental and psychical status. A serious attempt must be made, as a part of the routine preoperative assessment, to assess and document not only the physical but also the mental status of patients undergoing anaesthesia and surgery.

TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT0249219.

Place, publisher, year, edition, pages
Springer, 2019
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-73538 (URN)10.1007/s00268-019-04995-z (DOI)000473525500010 ()30937487 (PubMedID)2-s2.0-85068542993 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-08-08Bibliographically approved
Nilsson, U., Dahlberg, K. & Jaensson, M. (2019). Low Preoperative Mental Health can lead to Poorer Postoperative Recovery in Patients Undergoing Day Surgery. In: : . Paper presented at SFAI-veckan, Gothenburg, Sweden, September 11-13, 2019.
Open this publication in new window or tab >>Low Preoperative Mental Health can lead to Poorer Postoperative Recovery in Patients Undergoing Day Surgery
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-76196 (URN)
Conference
SFAI-veckan, Gothenburg, Sweden, September 11-13, 2019
Available from: 2019-09-10 Created: 2019-09-10 Last updated: 2019-09-10Bibliographically approved
Nilsson, U., Jaensson, M., Dahlberg, K. & Hugelius, K. (2019). Postoperative recovery after general and regional anesthesia in patients undergoing day surgery: A mixed methods study. Journal of Perianesthesia Nursing, 34(3), 517-528
Open this publication in new window or tab >>Postoperative recovery after general and regional anesthesia in patients undergoing day surgery: A mixed methods study
2019 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 3, p. 517-528Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate differences and describe experiences of postoperative recovery after day surgery between patients undergoing general anesthesia (GA) versus regional anesthesia (RA).

Design: A mixed methods design.

Methods: Day surgery patients (N = 401) were included. Postoperative recovery was assessed daily for 14 days using the Swedish Web Version of the Quality of Recovery questionnaire included in a mobile application. In addition, qualitative interviews were completed with 20 day surgery patients. Quantitative and qualitative data were first analyzed separately and then merged.

Findings: There were significant differences in Swedish Web Version of the Quality of Recovery between GA and RA on days 1 to 13 (P < .05). These findings could not be confirmed in the qualitative findings, except for psychological issues as well as tiredness and fatigue. Unexpected issues contributed to a greater extent to the theme not feeling well Pain in the surgical wound was overall the biggest problem.

Conclusions: There seems to be a poorer recovery after GA compared with RA. Tiredness or fatigue is present also after minor surgery in RA. Unexpected issues affect recovery negatively, and therefore should be addressed by health care.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
day surgery, fatigue, mixed methods, patient experience, patient-reported outcomes, postoperative
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-68568 (URN)10.1016/j.jopan.2018.08.003 (DOI)000469462400009 ()30470465 (PubMedID)2-s2.0-85057033263 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2019-06-18Bibliographically approved
Wångdahl, J., Dahlberg, K., Jaensson, M. & Nilsson, U. (2019). Psychometric validation of Swedish and Arabic versions of two Health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: A study protocol. BMJ Open
Open this publication in new window or tab >>Psychometric validation of Swedish and Arabic versions of two Health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: A study protocol
2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055Article in journal (Refereed) In press
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-76197 (URN)10.1136/bmjopen-2019-029668 (DOI)
Available from: 2019-09-10 Created: 2019-09-10 Last updated: 2019-09-10Bibliographically approved
Dahlberg, K., Jaensson, M. & Nilsson, U. (2019). RAPP - digital uppföljning efter dagkirurgi. Svensk Kirurgi, 77(1), 37-39
Open this publication in new window or tab >>RAPP - digital uppföljning efter dagkirurgi
2019 (Swedish)In: Svensk Kirurgi, ISSN 0346-847X, Vol. 77, no 1, p. 37-39Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Stockholm: Svensk kirurgisk förening, 2019
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-76460 (URN)
Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2019-09-17Bibliographically approved
Jaensson, M., Dahlberg, K., Nilsson, U. & Stenberg, E. (2019). The impact of self-efficacy and health literacy on outcome after bariatric surgery in Sweden: a protocol for a prospective, longitudinal mixed methods study. BMJ Open, 9(5), Article ID e027272.
Open this publication in new window or tab >>The impact of self-efficacy and health literacy on outcome after bariatric surgery in Sweden: a protocol for a prospective, longitudinal mixed methods study
2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e027272Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: A person-centred approach, to know about a person's individual weaknesses and strengths, is warranted in today's healthcare in Sweden. When a person suffers from obesity, there are not only risks for comorbidities but also increased risk for decreased health-related quality of life (HRQoL). After bariatric surgery, there are also risks for complications; however, healthcare service expects the person to have sufficient ability to handle recovery after surgery. The need is to investigate how a person's self-efficacy and health literacy(HL) skills are important to determine their effect on recovery as well as HRQoL after bariatric surgery. It can, involve the person in the care, improve shared decision-making, and perhaps decrease complications and readmissions.

METHOD AND ANALYSIS: This is a prospective, longitudinal mixed-methods study with the intent of including 700 patients from three bariatric centres in Sweden (phase 1); 20 patients will be included in a qualitative study (phase 2). Inclusion criteria will be age >17 years, scheduled primary bariatric surgery and ability to read and understand the Swedish language in speech and in writing. Inclusion criteria for the qualitative study will be patients who reported a low self-efficacy, with a selection to ensure maximum variation regarding age and gender. Before bariatric surgery patients will answer a questionnaire including 20 items. Valid and reliable instruments will be used to investigate general self-efficacy (10 items) and functional and communicative and critical HL (10 items). This data collection will then be merged with data from the Scandinavian Obesity Surgery Registry. Analysis will be performed 30 days, 1 year and 2 years after bariatric surgery. One year after bariatric surgery the qualitative study will be performed. The main outcomes are the impact of a person's self-efficacy and HL on recovery after bariatric surgery.

ETHICS AND DISSEMINATION: The study has received approval from the ethical review board in Uppsala, Sweden (number 2018/256). The study results will be disseminated through peer-reviewed publications and conference presentations to the scientific community and social media.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Bariatric surgery, health literacy, postoperative period, self-efficacy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-73583 (URN)10.1136/bmjopen-2018-027272 (DOI)000471192800262 ()31076473 (PubMedID)2-s2.0-85065722307 (Scopus ID)
Note

Funding Agency:

Örebro University  ORU 2018/00376  ORU 2018/01219

Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-07-22Bibliographically approved
Hälleberg Nyman, M., Nilsson, U., Dahlberg, K. & Jaensson, M. (2018). Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery Secondary Analysis of a Randomized Clinical Trial. JAMA Surgery, 153(8), 738-745
Open this publication in new window or tab >>Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery Secondary Analysis of a Randomized Clinical Trial
2018 (English)In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 153, no 8, p. 738-745Article in journal (Refereed) Published
Abstract [en]

Importance: Day surgery puts demands on the patients to manage their own recovery at home according to given instructions. Low health literacy levels are shown to be associated with poorer health outcomes.

Objective: To describe functional health literacy levels among patients in Sweden undergoing day surgery and to describe the association between functional health literacy (FHL) and health care contacts, quality of recovery (SwQoR), and health-related quality of life.

Design, Setting, and Participants: This observational study was part of a secondary analysis of a randomized clinical trial of patients undergoing day surgery and was performed in multiple centers from October 2015 to July 2016 and included 704 patients.

Main Outcomes and Measures: The primary end point was SwQoR in the FHL groups 14 days after surgery. Secondary end points were health care contacts, EuroQol-visual analog scales, and the Short Form (36) Health Survey in the FHL groups.

Results: Of 704 patients (418 [59.4%] women; mean [SD] age with inadequate or problematic FHL levels, 47 [16] years and 49 [15.1], respectively), 427 (60.7%) reported sufficient FHL, 223 (31.7%) problematic FHL, and 54 (7.7%) inadequate FHL. The global score of SwQoR indicated poor recovery in both inadequate (37.4) and problematic (22.9) FHL. There was a statistically significant difference in the global score of SwQoR (SD) between inadequate (37.4 [34.7]) and sufficient FHL (17.7 [21.0]) (P < .001). The patients with inadequate or problematic FHL had a lower health-related quality of life than the patients with sufficient FHL in terms of EuroQol-visual analog scale scores (mean [SD], 73 [19.1], 73 [19.1], and 78 [17.4], respectively; P = .008), physical function (mean [SD], 72 [22.7], 75 [23.8], and 81 [21.9], respectively; P < .001), bodily pain (mean [SD], 51 [28.7], 53 [27.4], and 61 [27.0], respectively; P = .001), vitality (mean [SD], 50 [26.7], 56 [23.5], and 62 [25.4], respectively; P < .001), social functioning (mean [SD], 73 [28.2], 81 [21.8], and 84 [23.3], respectively; P = .004), mental health (mean [SD], 65 [25.4], 73 [21.2], and 77 [21.2], respectively; P < .001), and physical component summary (mean [SD], 41 [11.2], 42 [11.3], and 45 [10.1], respectively; P = .004). There were no differences between the FHL groups regarding health care contacts.

Conclusions and Relevance: Inadequate FHL in patients undergoing day surgery was associated with poorer postoperative recovery and a lower health-related quality of life. Health literacy is a relevant factor to consider for optimizing the postoperative recovery in patients undergoing day surgery.

Place, publisher, year, edition, pages
American Medical Association, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology Surgery
Identifiers
urn:nbn:se:oru:diva-66778 (URN)10.1001/jamasurg.2018.0672 (DOI)000441758600015 ()29710226 (PubMedID)2-s2.0-85051572829 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2019-03-26Bibliographically approved
Dahlberg, K. (2018). e-Assessed follow-up of postoperative recovery: developement, evaluation and patient experiences. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>e-Assessed follow-up of postoperative recovery: developement, evaluation and patient experiences
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The majority of all surgeries are performed as day surgery. After discharge, patients are expected to take responsibility for their postoperative recovery themselves. Recovery Assessment by Phone Points (RAPP) is an e-assessment developed for assessing and providing follow-up on postoperative recovery, which includes the Swedish web-version of the Quality of Recovery questionnaire (SwQoR). It also enables the patient to get in contact with the day surgery unit. The overall aim of this thesis was to further develop and evaluate a systematic follow-up of postoperative recovery using a mobile app in adult persons undergoing day surgery, as well as to describe their experiences of postoperative recovery when using the mobile app. Study I: This study included three steps. Equivalence testing between the paper and app versions of the SwQoR showed agreement (n=69). The feasibility and acceptability evaluation showed that participants (n=63) were positive towards using a mobile phone application during postoperative recovery. Content validity of the SwQoR reduced the original 31 items to 24. Studies II and III: A multicentre, two-group, parallel, single-blind randomized controlled trial including 997 participants was conducted to investigate the effect of e-assessment on postoperative recovery (II) and cost-effectiveness (III) in a RAPP group compared with a control group. The RAPP group reported significantly better quality of postoperative recovery on postoperative days 7 and 14 compared with the control group. Moreover, RAPP may be cost-effective as it provides low-cost care. Study IV: Explored experience of postoperative recovery in participants using a mobile phone app during their postoperative recovery. Qualitative inductive semi-structured interviews (n=18) were performed. Findings showed that feeling safe is important during postoperative recovery. This feeling can be created by patients themselves, but sufficient support and information from health care and next of kin is needed. Overall, this thesis showed positive results for RAPP, suggesting that RAPP is a solution that may benefit patients after day surgery.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 97
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 182
Keywords
Ambulatory surgery, cost-effectiveness, eHealth, mobile applications, postoperative recovery, qualitative research, randomised controlled trial
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-65776 (URN)978-91-7529-249-6 (ISBN)
Public defence
2018-06-15, Örebro universitet, Forumhuset, Hörsal F, Fakultetsgatan 1, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-14 Created: 2018-03-14 Last updated: 2019-03-26Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4170-6451

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