Original research
Postoperative recovery at home after ambulatory gynecologic laparoscopic surgery

https://doi.org/10.1016/S1089-9472(03)00181-3Get rights and content

Abstract

The purposes of this descriptive, correlational study were to measure pain, fatigue, and functional limitations affecting the “at home” recovery process for ambulatory gynecologic laparoscopic surgery and to explore the relationships between these variables and the return to normal activities. Subjects (N = 91) recorded daily ratings of pain, fatigue, and function on a Home Recovery Log for 6 days postoperatively. The findings indicate that 95% of subjects resumed basic self-care activities such as dressing, bathing, and eating by postoperative day (POD) 3; however, less than 40% of subjects were able to perform other role functions such as shopping, laundry, and work outside of the home. A logistic regression model indicated that pain ratings and functional status on POD 2 were the best predictors of subjects who would need more than 5 days to resume their usual activities and routines. The findings have implications for preoperative teaching and telephone follow-up for ambulatory surgery patients. Preoperative teaching should prepare women for the additional days needed for recovery of instrumental activities of daily living to enable them to make alternate plans as necessary. Furthermore, because pain on POD 2 was the single most significant predictor of delayed recovery, moving the follow-up phone call from the morning to the late afternoon of POD 1 may help the nurse to identify patients who will need extra assistance with pain management.

Section snippets

Review of the literature

Recovery from ambulatory surgery is defined by patients as an absence of symptoms and a resumption of their usual activities and routines.15 Patients’ perceptions of the extent of their recovery can differ significantly from the same estimations given by trained nurse observers.16 In some studies, high and low levels of recovery were not related to age, sex, education, work status, procedure type, previous surgical experience, or the number of hours between completion of the surgery and

Research questions

The current study was designed to answer the following research questions: (1) What are patients’ patterns of pain, fatigue, functional limitations, and return to usual activities during the first week of recovery at home after laparoscopic gynecologic ambulatory surgery? (2) To what degree do pain, fatigue, and functional limitations predict the likelihood that a subject will have a delayed recovery after ambulatory gynecologic laparoscopy?

Methods

Consecutive, nonrandom sampling was used to select study participants. During the study period, 224 women were scheduled for gynecologic, laparoscopic procedures at the ambulatory surgical unit (ASU) of a large, urban, acute care medical center in the northeastern United States. Following approval by the Institutional Review Board, an introductory letter and a one-page abstract of the study explaining the aims of the study and the sample criteria were sent to surgeons and gynecologists at the

Results

Because one dimension of the outcome of interest, recovery, is the absence of symptoms, Table 2 displays the percentages of subjects at each level of pain for PODs 1 to 6. At the time of discharge from the ASU, 91.2% of subjects rated their pain as mild, an indication of adequate pain management by professional standards.18, 19 However, on the afternoon of POD 1, the percentage of subjects reporting moderate pain (40.7%) had increased and was almost equal to those reporting mild pain (44%). It

Discussion

The importance of pain management for the recovery process was confirmed in this study because pain was the most significant predictor of whether a subject would have a delayed recovery process (ie, need 6 or more days to recover). The influence of pain on the return to usual activities and routines suggests the need for better pain management beyond 24 hours after surgery. Infiltration of the operative site with local anesthetics has been shown to improve pain control, but the effect is often

Conclusions

There are many elements of postoperative nursing care that affect the full recovery of ambulatory patients; however, if only one change is made in the postoperative nursing care of ambulatory surgery patients, then calling patients later in the day on POD 1 may have the biggest impact. Diminishing the recovery process by just one day would be a worthwhile goal from the perspective of patients, families, and employers. Further nursing research is required to determine whether the timing of the

Acknowledgements

The author thanks the nursing staff of the ambulatory surgery unit at Beth Israel Deaconess Medical Center for their assistance; the members of her dissertation committee, Dr. Dorothy Jones, Dr. Joan Fitzmaurice, and Dr. Jean O’Neill, for their guidance; Dr. Joyce Clifford for her continuous support; and Dr. Ann Hurley for her persistent encouragement.

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    1

    Kathy J. Horvath, PhD, RN, is the Associate Director for Education and Program Evaluation at the Geriatric Research Education and Clinical Center (G.R.E.C.C.), E.N. Rogers Memorial Veterans Hospital (182B), Bedford, MA.

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