Convalescence advice following gynaecological surgery

Naidu, Madhu; Sultan, Abdul H.; Thakar, Ranee

doi:10.3109/01443615.2012.693983

Cited by 20 publications

(19 citation statements)

References 10 publications

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“…The primary outcome measure in this study is sick leave duration until first full RTW, defined as duration of sick leave in calendar days from the day of surgery until the actual day of full RTW in own work or in other work with equal earnings. Prolonged sick leave was defined as no RTW at 6 weeks after surgery, based on expert recommendations …”

Section: Methodsmentioning

confidence: 99%

Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands

Vonk‐Noordegraaf

Anema

Louwerse

et al. 2013

BJOG

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Objective To measure the impact of the level of invasiveness of gynaecological procedures on time to full Return to Work (RTW) and to identify the most important preoperative sociodemographic, medical and work-related factors that predict the risk of prolonged sick leave.Design Prospective cohort study.Setting Dutch university hospital.Population A total of 148 women aged 18-65 years scheduled for gynaecological surgery for benign indications.Methods A questionnaire regarding the surgical procedure as well as perioperative and postoperative complications was completed by the attending resident at baseline and 6 weeks after surgery. All other outcome measures were assessed using self-reported patient questionnaires at baseline and 12 weeks post-surgery. The follow-up period was extended up to 1 year after surgery in women failing to return to work. Surgical procedures were categorised into diagnostic, minor, intermediate and major surgery. A prediction model regarding the probability of prolonged sick leave at 6 weeks was developed, with a sensitivity of 89% and a specificity of 86%.Conclusions RTW often takes a long time, especially after intermediate and major surgery. This study reveals important predictors for prolonged sick leave and provides a prediction model for the risk of sick leave extending 6 weeks after benign gynaecological surgery in the Netherlands.

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Section: Methodsmentioning

confidence: 99%

Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands

Vonk‐Noordegraaf

Anema

Louwerse

et al. 2013

BJOG

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“…A reason might be the fact that convalescence is much more difficult to influence and monitor, especially now hospital stay is minimized and post-operative care is transferred to outpatient and primary care, and therefore, fragmented. In addition, there is a lack of recognised evidence-based convalescence recommendations for gynaecological procedures [4, 5], resulting in a situation in which structural convalescence recommendations regarding the resumption of (work)activities are mostly not provided at discharge, or when given, are based on tradition and anecdote [6–8]. …”

Section: Introductionmentioning

confidence: 99%

Process Evaluation of a Multidisciplinary Care Program for Patients Undergoing Gynaecological Surgery

Bouwsma

Noordegraaf

Szlávik³

et al. 2013

J Occup Rehabil

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Purpose This study describes the process evaluation of an innovative multidisciplinary care program for patients undergoing benign gynaecologic surgery. This care program aims at improving recovery and preventing delayed return to work and consists of two steps: (1) an interactive e-health intervention for all participants, and (2) integrated clinical and occupational care management for those participants whose sick leave exceeds 10 weeks. Methods Eligible for this study were employed women aged between 18–65 years scheduled for a laparoscopic adnexal surgery and/or hysterectomy. Data were collected from patients, their supervisors and their gynaecologists, by means of electronic questionnaires during a 6 month follow-up period and an automatically generated, detailed weblog of the patient web portal (www.ikherstel.nl). Investigated process measures included: reach, dose delivered, dose received, and fidelity. In addition, attitudes towards the intervention were explored among all stakeholders. Results 215 patients enrolled in the study and accounted to a reach of 60.2 % (215/357). All intervention group patients used their account at least once and total time spent on the patient web portal was almost 2 h for each patient (median 118 min, IQR 64–173 min). Most patients visited the website several times (median 11 times, IQR 6–16). Perceived effectiveness among patients was high (74 %). In addition, gynaecologists (76 %) and employers (61 %) were satisfied with the web portal as well. Implementation of the second step of the intervention was suboptimal. Motivating patients to consent to additional guidance and developing an accurate return-to-work-prognosis were two important obstacles. Conclusions The results of this study indicate good feasibility for implementation on a broad scale of the e-health intervention for patients undergoing benign gynaecological surgery. To enhance the implementation of the second step of the perioperative care program, adaptations in the integrated care protocol are needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s10926-013-9475-4) contains supplementary material, which is available to authorized users.

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“…The introduction of minimally invasive techniques in the last two decades has led to savings in in-hospital care due to shorter lengths of hospital stay, despite higher operative costs, longer operation time, and more expensive equipment [64-66]. However, early discharge does not necessarily lead to enhanced recovery, as postoperative recovery at home requires a different organization of perioperative care as well, such as preoperative patient education, including the deliverance of evidence-based standardized convalescence recommendations [6,8,9,12,67-70]. As far as we know, our care program is the first intervention developed, and being thoroughly evaluated, that anticipates this transition of perioperative care to the home setting.…”

Section: Discussionmentioning

confidence: 99%

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

Bouwsma¹,

Anema²,

Vonk‐Noordegraaf³

et al. 2014

JMIR Res Protoc

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BackgroundThe length of recovery after benign gynecological surgery and return to work frequently exceeds the period that is recommended or expected by specialists. A prolonged recovery is associated with a poorer quality of life. In addition, costs due to prolonged sick leave following gynecological surgery cause a significant financial burden on society.ObjectiveThe objective of our study was to present the protocol of a stepped wedge cluster randomized controlled trial to evaluate the cost effectiveness of a new care program for patients undergoing hysterectomy and/or adnexal surgery for benign disease, compared to the usual care.MethodsThe care program under study, designed to improve convalescence and to prevent delayed return to work, targets two levels. At the hospital level, guidelines will be distributed among clinical staff in order to stimulate evidence-based patient education. At the patient level, additional perioperative guidance is provided by means of an eHealth intervention, equipping patients with tailored convalescence advice, and an occupational intervention is available for those patients at risk of prolonged sick leave. Due to the stepped wedge design of the trial, the care program will be sequentially rolled out among the 9 participating hospitals, from which the patients are recruited. Eligible for this study are employed women, 18-65 years of age, who are scheduled for hysterectomy and/or laparoscopic adnexal surgery. The primary outcome is full sustainable return to work. The secondary outcomes include general recovery, quality of life, self-efficacy, coping, and pain. The data will be collected by means of self-reported electronic questionnaires before surgery and at 2, 6, 12, 26, and 52 weeks after surgery. Sick leave and cost data are measured by monthly sick leave calendars, and cost diaries during the 12 month follow-up period. The economic evaluation will be performed from the societal perspective. All statistical analyses will be conducted according to the intention-to-treat principle.ResultsThe enrollment of the patients started October 2011. The follow-up period will be completed in August 2014. Data cleaning or analysis has not begun as of this article’s submission.ConclusionsWe hypothesize the care program to be effective by means of improving convalescence and reducing costs associated with productivity losses following gynecological surgery. The results of this study will enable health care policy makers to decide about future implementation of this care program on a broad scale.Trial RegistrationNetherlands Trial Register: NTR2933; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2933 (Archived by WebCite at http://www.webcitation.org/6Q7exPG84).

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Convalescence advice following gynaecological surgery

Cited by 20 publications

References 10 publications

Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands

Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands

Process Evaluation of a Multidisciplinary Care Program for Patients Undergoing Gynaecological Surgery

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

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