Publication: Symptoms following day surgery: a review of the literature

Symptoms following day surgery: a review of the literature.
Rosen HR, Lauzon Clabo, LL, Mårtensson LM.
Journal of Advanced Perioperative Care 2009:7


Aim: The purpose of this paper was to provide a broad-based overview of the current literature regarding symptoms after day surgery. Background: The advent of new anaesthetic and anti-emetic agents, advanced surgical techniques and the need for reduced costs for inpatient hospital services, has resulted in about 70% of all surgical procedures being undertaken as day surgery in many countries such as the United Kingdom, Europe, Australia and North America. As more and more types of surgery, including increasingly complex procedures, are undertaken as day surgery and with the expansion of day surgery for patients who are older, frail or who have multiple co-morbidities, there is a need to expand the knowledge base regarding patients’ symptom experience at home following day surgery. In particular, there is a need to examine the patients’ experience of symptoms longitudinally and to examine the impact of these on the return to activities of daily living. Method: Nursing and health care papers published in English between 1992 and April 2008 were sought, using the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database. Thirty six papers were selected and critiqued. A checklist was used to review the included studies for their type of method and the way they were designed and implemented. Findings: The wide range of studies reviewed provided further understanding of incidence, intensity and duration of symptoms experienced by patients after day surgery. Patients´ almost invariably report that pain and other symptoms were at their peak up to 24 hours after discharge and frequently persisted for six days or more. However, a clear picture of the symptom experience following day surgery failed to emerge because methodological differences make comparison across studies difficult. While there has been little exploration of the symptom experience longitudinally, those studies that have examined symptoms over time suggest that the patient’s experience of them does have a significant impact on their ability to function in their normal social and work roles for a prolonged period of time following day surgery. In the studies reviewed when day surgery patients´ activity levels were reduced postoperatively, return to usual activity was delayed and activities of daily living were reported as difficult to manage. Conclusion: To conclude, this review demonstrates that patients´ experience of symptoms in the recovery period at home following day surgery is more profound than clinicians expect, lasts for a longer period and interferes with the ability to return to normal activities. However there are still gaps in knowledge particularly concerning the extent to which patients continue to experience symptoms after six days and beyond. Further research needs to explore multidimensional perspectives on symptoms together with an additional and more thorough evaluation of the impact of symptoms on daily living. Recommendations: Further research regarding these gaps in knowledge is necessary in order to develop a deeper understanding of patient’s symptom experience following day surgery and to develop appropriate assessment and intervention strategies for this population. The perioperative nurse with his or her specialised knowledge is well suited to face these challenges.

, from FoU i Sverige