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

Abstract

BackgroundConvalescence 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.MethodsThis 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.ResultsThere 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.ConclusionsThis 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 registrationDutch trial registry, NTR2087 (August 2009) and NTR2933 (June 2011).Electronic supplementary materialThe online version of this article (10.1186/s12893-017-0317-8) contains supplementary material, which is available to authorized users.

Factors Influencing Postoperative Recovery and Time Off Work of Patients with Benign Indications for Surgery – Results of a Prospective Study

“…Vonk Noordegraaf et al found that increasingly levels of invasiveness of surgical procedures were associated with an increased risk of longer times off work [20]. Another study has shown that the time until patients can resume everyday activities becomes longer when the invasiveness of the procedure increases [24]. Similarly, the patients in our study who underwent the most invasive procedures were off work longest.…”

“…Sometimes sick leave is extended beyond the recommended period at the request of the affected women [10]. In their study, Bouwsma et al found that both the period until patients returned to work and the period until various physical activities were resumed were longer than the period recommended by experts [24]. Moreover, patient expectations of having a long period of sick leave can lead to an extended sick leave [20].…”

Bridging different realities - a qualitative study on patients experiences of preoperative care for benign hysterectomy and opportunistic salpingectomy in Sweden

“…If convalescence was discussed in the consultation, the problems were expected to be understated. These perceptions are supported by a study comparing information provided by gynecologists regarding expected recovery after gynecological surgery with actual return to various activities of daily living (18). Insu cient knowledge while waiting for elective hysterectomy could lead to fear both regarding the indication for surgery as well as the surgery itself, although alleviated if there was a trust in the treating gynecologist.…”

Bridging different realities - a qualitative study on patients’ experiences of preoperative care for benign hysterectomy and opportunistic salpingectomy in Sweden

“…If convalescence was discussed in the consultation, the problems were expected to be understated. These perceptions are supported by a study comparing information provided by gynecologists regarding expected recovery after gynecological surgery with actual return to various activities of daily living [19]. Experiences of failed medical treatment prior to being accepted for hysterectomy, which is common due to the standard of exhausting the pharmacological options before surgery, would also influence the trust of the information given.…”