Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial

Dahlberg, Karuna; Philipsson, Anna; Hagberg, Lars; Jaensson, Maria; Nyman, Maria Hälleberg; Nilsson, Ulrica

doi:10.1093/bja/aex332

Cited by 48 publications

(49 citation statements)

References 27 publications

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“…This study is part of a mixed method study embedded [ 31 ] in a multicentre randomized controlled trial (RCT) evaluating cost-effectiveness and other aspects of an e-assessed follow-up using the Recovery Assessment by Phone Points (RAPP) after day surgery, compared with no e-assessed follow-up. The findings have been published in 2 previous papers [ 28 , 29 ]. The RAPP is a mobile app including the Swedish Web version of the Quality of Recovery questionnaire, which measures postoperative recovery [ 32 ], as well as asking the question whether the patient wants to be contacted by a nurse, in total consisting of 25 questions.…”

Section: Methodssupporting

confidence: 53%

Holding It Together—Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study

Dahlberg¹,

Jaensson²,

Nilsson³

et al. 2018

JMIR Mhealth Uhealth

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BackgroundThere is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery.ObjectiveThe aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery.MethodsThis is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis.ResultsA total of two themes and six subthemes emerged from the data: (1) the theme Give it all you’ve got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin.ConclusionsIt is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery.

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Section: Methodssupporting

confidence: 53%

Holding It Together—Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study

Dahlberg¹,

Jaensson²,

Nilsson³

et al. 2018

JMIR Mhealth Uhealth

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“…In 2008, Valderas et al recommended that future research should emphasize technological improvement, as well as the organizational and theoretical systems needed to create a care structure having patient-related outcomes as a fundamental element [ 27 ]. In our main study, 18.82% (n=338) of those assessed for eligibility (n=1796) did not have mobile phones or did not bring them to the day-surgery department [ 16 , 28 ], threatening the external validity. Even though 19% is low, we believe that this percentage will only decrease in the future, and adopting modern information technology to follow up patients’ postoperative recovery will be essential.…”

Section: Discussionmentioning

confidence: 99%

The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study

Nilsson

Dahlberg

Jaensson

2017

JMIR Mhealth Uhealth

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BackgroundThe 40-item Quality of Recovery (QoR-40) questionnaire is well validated for measuring self-assessed postoperative recovery. The Swedish version of the 40-item Quality of Recovery (QoR-40) has been developed into a Web-based questionnaire, the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire, adapted for use in a mobile app, Recovery Assessment by Phone Points, or RAPP.ObjectiveThe aim of this study was to test the validity, reliability, responsiveness, and clinical acceptability and feasibility of SwQoR.MethodsWe conducted a prospective psychometric evaluation study including 494 patients aged ≥18 years undergoing day surgery at 4 different day-surgery departments in Sweden. SwQoR was completed daily on postoperative days 1 to 14.ResultsAll a priori hypotheses were confirmed, supporting convergent validity. There was excellent internal consistency (Cronbach alpha range .91-.93), split-half reliability (coefficient range .87-.93), and stability (ri=.99, 95% CI .96-.99; P<.001). Cohen d effect size was 1.00, with a standardized response mean of 1.2 and a percentage change from baseline of 59.1%. An exploratory factor analysis found 5 components explaining 57.8% of the total variance. We noted a floor effect only on postoperative day 14; we found no ceiling effect.ConclusionsSwQoR is valid, has excellent reliability and high responsiveness, and is clinically feasible for the systematic follow-up of patients’ postoperative recovery.

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“…The main study of this project [21] included 1027 patients, 756 (73.6%) of whom completed the SwQoR scale on POD 7 ( Table 1). The mean MCS was 48.3 (SD 10.8) and the mean PCS 44.9 (SD 10.3).…”

Section: Resultsmentioning

confidence: 99%

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

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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.

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Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial

Abstract: NCT02492191.

Cited by 48 publications

References 27 publications

Holding It Together—Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study

Holding It Together—Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study

The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study

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

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